Liver abscess

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Overview

A liver abscess is a pus-filled mass inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis. With treatment, the death rate is 10-30%.

General Characteristics of Liver Abscess

• Biliary tract disease is the most common cause but no cause identified in the majority of patients.
• Nonspecific clinical findings - high degree of suspicion required for diagnosis
• Most often single, rather than multiple foci
• Hyperbilirubinemia and elevated alkaline phosphatase in the majority of patients, but low specificity.
• E. coli the most prevalent organism, followed by Klebsiella, Streptococcus, and Bacteroides species.
• Rare cause is bowel perforation following foreign body ingestion
• Therapy for solitary liver abscess from causes other than bowel perforation is intravenous antibiotics and percutaneous US- or CT-guided drainage
• Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage
• Amebic liver abscess occurs in 94% of cases of amebiasis
• Liver abscess is a relatively infrequent (1.7% according to Cho, D. et. al.), although possible, complication of percutaneous radiofrequency ablation of hepatic tumors.

Types

There are 3 major forms of liver abscess, classified by etiology:

1. Pyogenic abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States.
2. Amebic abscess due to Entamoeba histolytica accounts for 10% of cases.
3. Fungal abscess, most often due to Candida species, accounts for less than 10% of cases.