Pyogenic hepatic abscess in a community hospital.

Pyogenic hepatic abscesses are rare lesions and are most commonly the result of biliary tract disease. During a 3-year period at our institution, 15 patients were diagnosed with pyogenic hepatic abscess. Ten cases were related to biliary disease. Of these, five were associated with previous biliary tract operations. The remaining five were due to metastases, infection at another site, or cryptogenic causes. Most abscesses were multiple. Treatment consisted of antibiotics alone for three patients, percutaneous drainage and intravenous antibiotics for seven patients, open drainage with intravenous antibiotics for three patients, and papillotomy with intravenous antibiotics for one patient. The single untreated patient died. The other death occurred among those patients treated with intravenous antibiotics alone. Four patients initially treated by percutaneous drainage required subsequent open drainage. All of these patients had multiple abscesses. The mean length of stay in the hospital was least among the group treated by operative drainage. Our review suggests that pyogenic hepatic abscesses may be treated by several different modalities, the choice of management should be individualized, and the length of stay may be decreased by operative drainage.