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KVS Liew, TC Lau, CH Ho, TK Cheng, YS Ong, SC Chia, CC Tan
Correspondence: Dr Kenneth V.S.Liew
Aim of Study To perform a retrospective study, with the help of literature review, of the management of patients with pyogenic liver abscess in a general hospital.
Method A retrospective study of 73 consecutive patients treated at TanTock Seng Hospital between January 1994 and December 1997 was conducted to determine the demographic, clinical, laboratory, radiological and microbiological characteristics of these patients, as well as the management strategies employed.
Results Liver abscess was more common in males, occurring more frequently in the right hepatic lobe. Most patients presented with non-specific clinical and biochemical features. A raised alkaline phosphatase level was the most common biochemical abnormality found in about two-thirds of patients. Ultrasonography was not as sensitive as computed tomographic scans in detecting abscesses. Klebsiella pneumoniae was the most common etiological agent detected in cultures of blood and abscess aspirates. All patients were treated with intravenous antibiotics. Twenty-two (30%) needed percutaneous catheter drainage and five (7%) required surgical management. There was no hospital mortality in our series. Prolonged hospitalisation was associated with advanced age, degree of loculation within the abscess, concomitant diabetes mellitus and Klebsiella septicaemia.
Conclusion Pyogenic liver abscesses require a high index of suspicion for early diagnosis. When appropriate therapy in the form of antibiotics in combination with percutaenous drainage or surgery is administered, mortality is very low. However, significant morbidity is still a problem, particularly in the elderly, diabetic patient.
Keywords: Pyogenic liver abscess, Klebsiella pneumoniae, percutaneous catheter drainage
Singapore Med J 2000; 41(10): 489-492