title: Liver abscess in adults: ten years experience in a UK centre.
abstract: BACKGROUND
  The epidemiology and management of liver abscess (LA) have evolved over time.
  
  
  OBJECTIVE
  To examine our experience over 10 years in a UK teaching centre.
  
  
  METHODS
  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 >/=60 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Guy's, King's and St Thomas' School of Medicine, King's College London, UK. Abdul.Mohsen@kcl.ac.uk
authors.forename: A H
authors.initials: AH
authors.lastname: Mohsen
authors.forename: S T
authors.initials: ST
authors.lastname: Green
authors.forename: R C
authors.initials: RC
authors.lastname: Read
authors.forename: M W
authors.initials: MW
authors.lastname: McKendrick
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008100:Liver Abscess / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology