Cut it out: Managing hepatic abscesses in patients with chronic granulomatous disease.
BACKGROUND
Hepatic abscesses develop in patients with chronic granulomatous disease (CGD) because the liver is a site of constant bacterial challenge. The authors investigated the roles of drainage and hepatic resection in the management of liver abscesses in CGD patients.


METHODS
Medical records of CGD patients with hepatic abscesses from 1990 to 2001 were reviewed.


RESULTS
There were 6 patients. Mean age of initial abscess was 7.2 years (range, 3 weeks to 18.9 years). All abscesses involved the right lobe of the liver (2 single, 4 multiple). All patients received appropriate antibiotics. Four patients were treated with one to 6 drainage procedures over one to 4 admissions before ultimately undergoing resection. The other 2 patients underwent primary resection without preliminary drainage. Of the 6 resections, 4 were nonanatomic, and 2 were anatomic. There was one major postoperative complication (bleeding) requiring reoperation. There were no recurrences after resection (mean follow-up 4.3 yr). Mean total days in hospital for the treatment of liver abscess was 49 in the preliminary drainage group and 8.5 in the primary resection group. Three patients required admission into the intensive care unit, one after a drainage procedure and 2 after resection.


CONCLUSIONS
For CGD patients with hepatic abscesses, drainage procedures are associated with recurrence and prolonged hospitalization. Primary hepatic resection removing all involved tissue is safe and definitive for the management of this problem.
St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA.
Li Ern
LE
Chen
Robert K
RK
Minkes
Penelope G
PG
Shackelford
Steven M
SM
Strasberg
Elbert Y
EY
Kuo
Jacob C
JC
Langer
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000150:complications*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008099:Liver / Q000601:surgery*; D008100:Liver Abscess / Q000209:etiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome