Pyogenic liver abscess: Changing patterns in approach

Table 1 Origin of pyogenic liver abscess

No.	Origin	n (%)
1	Biliary calculi	45 (26.62)
2	Biliary ascariasis	30 (17.75)
3	Cholecystitis/cholangitis	33 (19.52)
4	General sepsis/hematogenous seeding	19 (11.24)
5	Pancreatitis	11 (7.00)
6	Portal vein sepsis	6 (3.82)
7	Recent gastric or duodenal surgery	3 (1.91)
8	Cryptogenic	22 (13.01)
	Total	169 (100)

Table 2 Symptoms and signs

No.	Symptoms	%	Signs	%
1	Malaise	98	Abdominal tenderness	70
2	Anorexia	92	Hepatomegaly	65
3	Fever	91	Right upper quadrant pain	62
4	Weight loss	75	Pulmonary changes	38
5	Chills	35	Jaundice	34
6	Vomiting	18	Epigastric pain	14
7	Chest pain	15	Peripheral Edema	9
8	Nigh sweats	12	Splenomegaly	8
9	Cough	12	Diffuse pain	7
10	Diarrhoea	10	Right flank pain	4

Table 3 Various modalities of management used in the patients

No.	Treatment modality	n	Success rate (%)
1	Open surgical drainage	127	122 (96)
2	Percutaneous drainage	26	20 (77)
3	iv antibiotics only	16	6 (37.5)
	Total	169

Nine patients with open surgical drainage had to undergo re-exploration as they had recurrence of abscess.

Table 4 Operative procedures performed on the patients

No.	Operative procedure	n
1	Drainage of abscess alone	62
2	Draining of abscess with cholecystectomy with common bile duct exploration	53
3	Drainage of abscess with cholecystectomy	7
4	Drainage of abscess with peritoneal lavage	5
	Total	127

Table 5 Major complications and their frequency

No.	Complication	%
1	Septicemia	22
2	Intra Abdominal abscess	11
3	Recurrent liver abscess	4
4	Renal failure	4
5	Hepatic Failure	3
6	Massive upper gastrointestinal blood	3
7	Free peritonitis	2
8	Prolonged billiary drainage	2
9	Mortality
	Non surgical group	7/42 (16.66)
	Surgical group	12/127 (9.44)

Table 6 Impact of co-morbidity on mortality

Comorbidity	No. of deaths in surgical group (n = 12)	No. of deaths in non-surgical group (n = 7)	Total deaths (n = 19)	P-value
Diabetes (n = 4)	1	2	3	> 0.05
Chronic obstructive pulmonary disease (n = 5)	2	2	4	< 0.05
Anemia (n = 35)	4	3	7	< 0.05

P > 0.05 (insignificant), P < 0.05 (significant).

Table 7 Impact of organism cultured on the outcome of disease

Complications [organism(s) cultured]	Recurrent sepsis		Acute respiratory distress syndrome		Wound infection		Recurrence		Mortality
	S	NS	S	NS	S	NS	S	NS	S	NS
Escherichia coli	1	1	0	0	1	0	1	1	2	2
Klebsiella pneumonia	2	2	1	1	0	0	1	1	6	4
Streptococcus pneumonia	1	0	1	1	0	0	0	0	1	0
Staphylococcus epidermidis	0	0	0	0	0	0	0	0	0	0
Staphylococcus aureus	0	0	1	0	1	0	0	0	0	0
Bacteriodes fragilis	1	0	0	0	0	0	1	0	1	1
Pseudomonas aeruginosa	1	1	0	0	0	0	0	0	2	0

S: Significant; NS: Non significant.