For the understanding of the changing patterns of clinical features, therapies and prognosis of pyogenic liver abscesses. 178 cases admitted to the Yonsei University Medical College Hospital over the past 20 years (1971-1990) were reviewed.
Additionally, these cases were divided into 68 cases of the 1970's and 110 cases of the 1980's and which were reviewed comparatively. Most liver abscesses (87%) were located in the right lobe and 36% of abscesses were multiple. The size of
abscess
decreased (p<0.05) and the number of abscess tended to increase (p<0.1) in the 1980's compared with that of 1970's. The pus culture was positive in 82% with a prevalence of gram (-) bacilli. Of these cultures, E. coli was the most frequently
found
organism (30%) and anaerobes were cultured in 12%. The common associated diseases were diatetes mellitus (14%), malignancy (17%) and pyelonephritis (5%). Diabetes mellitus was more prevalent in the 1980's (22%) than in the 1970's (1%) (p<0.05).
The
most
common origin of abscess in decreasing order of frequency was transbillary infection (43%). hematogenous, trauma associated. portal origin. The ascending infection through the biliary tract as the origin of liver abscess have increased
significantly
from 31% in the 1970's to 51% in the 1980's (p<0.05). The treatment of pyogenic liver abscesses were open drainage in 63 cases (35%) and aspiration drainage in 116 cases (65%). The incidence of complications was 69% and the frequent complications
were
pulmonary (56%), acute renal failure (10%), peritonitis (8%), subphrenic or subhepatic abscess (8%). Overall mortality rate was 17% and the important factors associated with significant increase in mortality rate were sepsis, acute renal failure
and
compbined malignancies. In conclusion, there was no diffeence in the clinical features and porgnosis of pyogenic liver abscesses between the 1970' and the 1980's. However, ascending intections through the biliary tract as the etiology of liver
abscesses wee more common in the 1980's and the incidence of liver abscesses in critically ill patietns with malignancy or diabetes mellitus were increased in the 1980;s. Sensitive antibiotics administration and proper drainage are the
cornerstones
of
effective therapy.
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