Section: Hepatobiliary Sub-section: Liver Curriculum: Curriculum, page 86
Definition
Pus filled mass in the liver that can develop from injury or intraabdominal infection
Epidemiology
Rare
Aetiology
- Biliary causes e.g. choledocholithiasis, malignant obstruction
- Direct extension from perforation of adjacent organ e.g. gallbladder, colon, stomach, duodenum
- Intraabdominal infections – e.g. diverticulitis, IBD, appendicitis (rare)
- Non-GI source – bacterial endocarditis, urinary sepsis, pneumonia, osteomyelitis, IVDU
Organisims
- Most commonly enteric organisms – Escherichia coli, klebsiella pneumonia
Clinical
- Fevers, chills
- RUQ pain
- Jaundice
- Anorexia, malaise
- Raised WCC, CRP and abnormal LFTs
Investigations
- USS shows fluid filled cavity, and can provide info on no. of lesions, diameter and anatomical location, and bile duct dilatation.
- MRCP should be considered if biliary cause
- CT shows hypodense lesion with thick wall
Management
- < 3 cm treated successfully with abx only
- > 3 cm unilocular, combination of abx and perc drainage
- > 3 cm complex multiloculated – surgical drainage
- All hepatic abscesses not caused by malignancy should be first treated by abx and perc drain, if fails then operation can be considered (video assisted abscess debridement, laparoscopic drainage, or resection in exceptional circumstance)
- High mortality rate ~7-10%