title: Liver abscess presentation and management in Saudi Arabia and the United Kingdom.
abstract: OBJECTIVE
  Liver abscess (LA) is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom (UK).
  
  
  METHODS
  Retrospective review of LA patients from three tertiary care centers (2 from Saudi Arabia and 1 from the UK) over a period of 10 years, from 1995 to 2005.
  
  
  METHODS
  Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome.
  
  
  RESULTS
  A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean (SD) age was 45.2 (20.3) years for those from Saudi Arabia and 55.4 (18.8) years for those from the UK (P=.022). The majority of the patients were males (70% from Saudi Arabia and 80% from the UK). Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 (80%) patients. Organisms were isolated in 43 (52%) cases and the majority of these were coliforms (58%). Amebic liver abscesses occurred in 19 (23%) patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 (80%) patients with aspiration and/or antibiotics, and 9 (10.8%) patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome (P=.008, .029 and .001, respectively).
  
  
  CONCLUSIONS
  Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Riyadh Military Hospital, Riyadh, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Albenmousa
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Sanai
authors.forename: Amit
authors.initials: A
authors.lastname: Singhal
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Babatin
authors.forename: Adnan A
authors.initials: AA
authors.lastname: AlZanbagi
authors.forename: Malfi M
authors.initials: MM
authors.lastname: Al-Otaibi
authors.forename: Altaf H
authors.initials: AH
authors.lastname: Khan
authors.forename: Khalid I
authors.initials: KI
authors.lastname: Bzeizi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000150:complications; D007223:Infant; D008100:Liver Abscess / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008101:Liver Abscess, Amebic / Q000503:physiopathology / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D014195:Travel; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000469:Alkaline Phosphatase