Changing management of pyogenic liver abscess.

The case records of 23 patients who presented over a 5-year period with a diagnosis of pyogenic liver abscess were reviewed. Ascending cholangitis was implicated in nine cases, seven of which were associated with underlying malignancy. Haematogenous spread via the portal route accounted for five cases. Primary treatment included percutaneous abscess drainage in 15 patients. Whereas nine of the 11 patients with benign underlying pathology were managed successfully, the four with malignant biliary obstruction did not survive. Only one of the 23 patients who presented with hepatic abscess required surgical intervention. Percutaneous abscess drainage combined with appropriate antibiotic therapy is an effective means of managing hepatic abscess, but there remains a substantial overall mortality rate resulting from the increasing incidence of malignant biliary obstruction as a cause of this condition.