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Pyogenic liver abscess -- 20 years' experience. Comparison of results of treatment in two periods.

BACKGROUND AND AIMS
Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study.


PATIENTS/METHODS
In two equal periods between 01.01.1982 and 31.03.2001, 56 patients (37 males and 19 females) with pyogenic liver abscess were treated. Image-guided percutaneous drainage was performed in 22.2%/20.6% of the patients; the remainder were treated with open drainage with or without biliary tract reconstruction and liver resection. For antibiotic perfusion of the liver an umbilical vein cannula was inserted in 40.7%/24.1%. Microbiological findings, types of therapy, complications and mortality, etiology, patient characteristics, symptoms, and laboratory data were investigated. The results in the two groups were compared and analyzed statistically.


RESULTS
The most common cause of abscess, biliary disease, was seen more often in the second period. Solitary liver abscesses were more frequent. The only characteristic biochemical finding was an elevated alkaline phosphatase level. There were more positive cultures in the second period (70.4%/79.3%), and the number of Escherichia coli or Enterobacter aerogenes infections also increased. In the first period the mortality was 18.5%, whereas in the second no patients were lost.


CONCLUSION
We suggest the importance of individualized therapy based on an early and exact diagnosis. The first treatment step should be image-guided drainage, but under well-defined circumstances open drainage can also be performed with good results.