Liver abscess--a clinical study.

Forty consecutive cases of liver abscess from the Department of Medicine III, Singapore General Hospital, from 1978 to July 1983 were reviewed. Nineteen (47.5%) were amoebic, 15 (37.5%) pyogenic and 6 (15%) of unknown aetiology. Of the first 20 cases from 1978 to 1980, amoebic abscesses (60%) predominated. An increased incidence of pyogenic abscess constituting 50% was seen in the next 20 cases. Though all racial groups were affected, a predilection among Indians was seen. Males outnumbered females (4:1), and peak incidence occurred in the 40 to 70 age group (62.5%). Fifty percent presented early (less than one week of symptoms) to hospital. Common physical signs were fever (97.5%) and hepatomegaly (92.5%). Investigations showed leucocytosis in excess of 10,000 WBCs/cmm (87.5%), an ESR of 80 mm/hr (80%) and an elevated alkaline phosphatase of at least twice normal (73.6%). Single abscesses (72.5%) located in the right lobe were more likely to be amoebic. Where abscesses were multiple, they were more likely to be pyogenic (63.6%). Two-thirds of the pyogenic abscesses were due to either Klebsiella species or E. coli. Medical treatment consisted of broad spectrum antibiotics, usually in combination with metronidazole. Aspiration or drainage (open or closed) was employed when indicated. These were carried out more often for pyogenic than amoebic abscesses. Amoebic abscesses responded faster to treatment compared to pyogenic abscesses. Mortality in the first 20 cases prior to 1981 was 30%, being mainly confined to pyogenic abscesses. However, after 1981, there has been no mortality in the ensuing 20 cases.