Liver abscess in adults: ten years experience in a UK centre

Background: The epidemiology and management of liver abscess (LA) have evolved over time. Aim: To examine our experience over 10 years in a UK teaching centre. Design: Retrospective review of patient records. Methods: We reviewed the records of all patients aged >16 years discharged from Royal Hallamshire Hospital with a diagnosis of LA between April 1988 and December 1999. Results: There were 69 patients with LA (65 pyogenic, 4 amoebic), giving a crude annual incidence rate of 2.3/100 000/year (18.15/100 000 hospital admissions). Median age was 64 years. Single lesions were found in 41 patients, multiple lesions in 28. Pre-admission, patients were symptomatic for a median 14 days, with the most common symptoms and signs being fever and abdominal pain/tenderness. Pathogens were identified in 74% and predisposing aetiology in 92% of those undergoing investigation. Spread of infection to the liver via the portal venous system was the commonest route of infection (46%), most frequently in patients aged greater than or equal to60 years (p=0.019). Abdominal ultrasound (US) was diagnostic for LA in >90% of cases. Treatment with anti-microbial therapy plus interventional radiology was optimal. The case fatality rate was 12.3%, mainly from associated underlying pathology. Discussion: LA is commonly associated with underlying gastrointestinal pathology. Seeking out this underlying aetiology is an integral part of management. We recommend US as the first-line diagnostic tool with guided intervention plus antibiotic(s) as first-line treatment. Prognosis depends chiefly on the underlying pathology.