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Background & aims Pyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS). Methods The study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group ( n  = 91) and the non-BS group ( n  = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n  = 22) and non-bilioenteric anastomoses group (non-BEA, n  = 69). Clinical characteristics were recorded and analyzed. Results The percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities ( P  = 0.009 and P  = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus ( P  < 0.001) and solitary abscesses ( P  = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures ( P  = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history ( P  = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%). Conclusions Patients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.

PurposeTo identify the predictors for recovery of pyogenic liver abscess (PLA) patients treated with percutaneous catheter drainage (PCD) and antibiotics, and then develop an effective nomogram to predict the recovery time.Materials and methodsThe retrospective study included consecutive PLA patients treated with PCD and antibiotics. We defined the overall recovery time (ORT) as the time from the PCD procedure to the time of clinical success or failure. Based on the ORT, its predictors were identified with univariate and multivariate analyses. Then, a nomogram was developed to predict the ORT, and was internally validated by using Harrell’s c statistic.ResultsA total of 116 patients and 142 PCD procedures with a median ORT of 15.0±10.6 days were included. Gas-formation (GF; HR: 0.486 [95% CI 0.312–0.757]; P = 0.001), diabetes mellitus (DM; HR: 0.455 [95% CI 0.303–0.682]; P<0.001), and preinterventional septic shock (PSS; HR: 0.276 [95% CI 0.158–0.483]; P < 0.001) were identified as predictors for the ORT of combination therapy after univariate and multivariate analyses, which indicated a significantly longer ORT than those patients without. The prognostic analyses demonstrated that the more predictors (GF, DM, and PSS) a patient exhibited, the longer ORT for the combination therapy. A nomogram was developed to predict the ORT and revealed high accuracy, with Harrell’s c statistic of 0.73.ConclusionGF, DM, and PSS were predictors for the recovery of PLA patients treated with PCD and antibiotics. The nomogram was effective in predicting the ORT of combination therapy.

Background De novo hepatocellular carcinoma (HCC) complicated by pyogenic liver abscess is rare, and the standard of care for this disease has yet been defined. This study assesses whether liver resection can be recommended as its standard treatment. Methods This retrospective study reviewed the prospectively collected data of the 1725 patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2012. Outcomes were compared between patients with and without liver abscess. Results Twenty-two (1.28 %) patients had HCC and liver abscess. Fourteen of them received preoperative drainage. Patients with and without abscess had similar tumor characteristics, but patients with abscess had more operative blood loss (2.2 vs. 0.8 L; p  < 0.0001) and more of them needed blood transfusion (63.6 vs. 23.1 %; p  < 0.0001). They also had a longer hospital stay (38.5 vs. 10 days; p  < 0.0001), a higher hospital mortality (40.9 vs. 2.8 %; p  < 0.001), a higher postoperative complication rate (100 vs. 25.9 %; p  < 0.0001), and poorer 1, 3, and 5-years disease-free survival rates ( p  = 0.023). Conclusions The post-resection mortality of the patients with de novo HCC complicated by pyogenic liver abscess was so high that liver resection is not recommended as the standard treatment. More research is needed to determine the best therapy for this rare disease.

Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3 cm), Abscess Type II (large >3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and χ 2 used for comparison with a P < 0.05 considered significant. Our study consisted of 107 patients with pyogenic liver abscess. The success rate for small abscesses treated with antibiotics was 100 per cent. The success rate with antibiotics and percutaneous drainage for large, unilocular abscesses was 83 per cent and for large, multiloculated abscesses was 33 per cent. None of the 27 patients who had surgical therapy for large, multiloculated abscesses had recurrences. Surgical treatment for large (>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P ≤ 0.01). The mortality rate for the percutaneous drainage plus antibiotic group was not significantly different from the primary surgical group (4.2% versus 7.4%, P = 0.40). We propose a treatment algorithm with small abscesses being treated with antibiotics alone; large, uniloculated abscess with percutaneous drainage plus antibiotics; and large, multiloculated abscessed treated with surgical therapy.

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre’s syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre’s syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.

Background To retrospectively compare the outcomes of percutaneously drained and laparoscopically drained liver abscesses. Methods Eight-five consecutive patients with radiological evidence of liver abscess were treated at National University Hospital of Singapore from 2005 to 2011. Multivariable logistic regression was used to identify failures of intervention. This was defined as persistent objective signs of sepsis. Complications, length of antibiotic therapy, and hospital stay were recorded but not used as indicators for failure of intervention. A propensity score analysis was used to adjust for possible confounders. Results Twenty-seven (40.3 %) patients in the percutaneous group did not respond to primary intervention compared to 2 patients (11.1 %) in the laparoscopic group ( p  = 0.020). Two patients within the percutaneous group died from progression of sepsis despite intervention. In the multivariate model with propensity score, laparoscopic drainage had a protective effect against failure compared to percutaneous drainage of liver abscess (odds ratio [OR], 0.03; 95 % confidence interval [CI], [0–0.4]; p  = 0.008). There were no differences in complications related to the intervention ( p  = 0.108). Mean duration of antibiotics ( p  = 0.437) and hospital stay ( p  = 0.175) between the groups was similar. Conclusions Laparoscopic drainage of cryptogenic liver abscesses should be considered as an option for drainage of liver abscess.

Objective. This study was designed to compare the effects of catheter drainage alone and combined with ozone in the management of multiloculated pyogenic liver abscess (PLA). Methods. The prospective study included 60 patients diagnosed with multiloculated PLA. All patients were randomly divided into two groups: catheter drainage alone (group I) and catheter drainage combined with ozone (group II). Drainage was considered successful when (1) the abscess cavity was drained and (2) clinical symptoms were resolved. Kruskal-Wallis nonparametric test was used to compare the success rates, length of stay (LOS), and need for further surgery of the two groups. P < 0.05 indicates significant difference. Results. All patients’ catheters were successfully placed under CT guidance. Group I was treated with catheters alone and group II was treated with catheters and ozone. The success rates of groups I and II were 86% and 96%, respectively ( P < 0.05 ). And compared with group II, the duration of fever in group I was longer ( P < 0.05 ), and the LOS was also longer ( P < 0.05 ). Conclusion. Catheter drainage combined with ozone is an effective and safe treatment in multiloculated PLA. The Clinical Registration Number is ChiCTR1800014865.

Introduction Pyogenic hepatic abscess induced by foreign body perforation of the gastrointestinal tract is an increasing phenomenon. Pyogenic liver abscess in itself is a challenge to treat without the complication of a foreign body. Methods A case of a patient who developed a pyogenic hepatic abscess after unknown ingestion of a toothpick that subsequently perforated the duodenum is presented, and a literature review of pyogenic hepatic abscesses secondary to ingestion of foreign bodies and their causes, diagnosis, and treatment was performed. Discussion Even with a thorough workup, often the diagnosis of a pyogenic hepatic abscess secondary to an endolumenal foreign body perforation is not obtained until the time of operation.

The annual incidence of pyogenic liver abscess has been estimated at 1.1-2.3 cases per 100 000 population.1,2 Incidence increases with age: people aged 65 years or older are 10 times more likely than younger people to develop pyogenic liver abscesses.1 This parallels the increased incidence of biliary tract disease in older populations. 3,4 Risk factors for pyogenic liver abscess include male sex, advanced age, biliary tract disease, diabetes mellitus, liver transplantation, malignancy and percutaneous treatments for hepatocellular carcinoma, including radiofrequency ablation.1,5 The most common clinical features include fever (73%), chills (45%) and right upper quadrant pain (38%). The most frequent laboratory abnormalities include hypoalbuminemia (96%), elevated γ-glutamyl transferase (81%), elevated alkaline phosphatase (71%) and leukocytosis (69%).1 Liver abscesses resulting from foreign-body migration most commonly occur in the left lobe of the liver, often as a result of perforation through the gastric antrum or proximal small bowel. Common foreign bodies include fishbones (44%), toothpicks (29%), chicken bones (8%), metallic objects (14%) and unidentified bones (5%).11 Clinical and laboratory features of liver abscess secondary to foreign-body migration are similar to those related to other mechanisms of infection.11 A systematic review of the literature that identified 60 instances of pyogenic liver abscess related to foreign-body migration suggested improved sensitivity of CT over ultrasonography for visualization of foreign bodies; however, imaging may be nondiagnostic in more than 50% of instances.11 A thickened gastrointestinal wall in contact with a liver abscess may suggest a migrated foreign body as the mechanism of infection. For instances in which a foreign-body mechanism is suspected and the foreign body is not seen on imaging, esophagogastroduodenoscopy is recommended.11 Findings at endoscopy may include direct visualization of the foreign body, mucosal inflammation and the presence of a fistulous tract. Endoscopy may assist with foreign-body removal. In some instances, exploratory laparotomy or laparoscopy may be needed to arrive at the diagnosis.11 In instances of liver abscess related to foreign- body migration, rates of cure without foreign- body removal are low (9.5%).11 Removal of the foreign body is critical to permitting resolution of the abscess and closure of fistulous tracts. Surgical drainage of the abscess at the time of removal of the foreign body appears to be an adequate means of source control (i.e., eradicating the focus of infection).11 There are limited data addressing the need for ongoing catheter drainage following surgical drainage in this situation. Surgical drainage is in principle similar to needle drainage, which has shown comparable efficacy to catheter drainage in instances of pyogenic liver abscess due to all causes.13