Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess.
OBJECTIVE
To evaluate the risk factors and clinical outcomes in patients with spontaneous rupture of pyogenic liver abscess (PLA).


METHODS
A total of 602 patients diagnosed with PLA between January 2004 and July 2013 were retrospectively analyzed. Among them, 23 patients experienced a spontaneous rupture of liver abscess (SRLA).


RESULTS
The prevalence of SRLA was 3.8%. Using multivariate analysis, liver cirrhosis (OR 4.651, P = 0.009), gas-forming abscesses (OR 3.649, P = 0.026), abscess ≥6 cm in diameter (OR 10.989, P = 0.002) and other septic metastases (OR 1.710, P = 0.047) were risk factors for SRLA. Regarding the site of rupture, 20 (87.0%) patients had a localized rupture, specifically, subphrenic abscess in 3 (13.0%), peri-hepatic abscess in 10 (43.5%), localized peritoneal abscess in 3 (13.0%) and empyema in 4 (17.5%); and the other 3 (13%) had peritonitis. Ruptures resulting in peritonitis require urgent surgery, whereas localized ruptures were managed with surgical or percutaneous drainage in addition to appropriate antibiotics. The in-hospital mortality rate of SRLA was 4.3%.


CONCLUSIONS
Patients with cirrhosis, having abscess ≥6 cm in diameter, gas-forming abscesses and other septic metastases in those with PLA should be monitored closely and may need early intervention for SRLA.
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chung Hwan
CH
Jun
Jae Hyun
JH
Yoon
Jin Woo
JW
Wi
Seon Young
SY
Park
Wan Sik
WS
Lee
Sook In
SI
Jung
Chang Hwan
CH
Park
Young Eun
YE
Joo
Hyun Soo
HS
Kim
Sung Kyu
SK
Choi
Jong Sun
JS
Rew
D018784:Abdominal Abscess / Q000209:etiology* / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage / Q000379:methods; D004653:Empyema / Q000209:etiology* / Q000628:therapy; D005260:Female; D005740:Gases; D017052:Hospital Mortality; D006801:Humans; D008100:Liver Abscess / Q000209:etiology* / Q000628:therapy; D046290:Liver Abscess, Pyogenic / Q000150:complications* / Q000628:therapy; D008103:Liver Cirrhosis / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010529:Peritoneal Cavity / Q000473:pathology; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000209:etiology / Q000628:therapy; D013369:Subphrenic Abscess / Q000209:etiology* / Q000628:therapy
D000900:Anti-Bacterial Agents; D005740:Gases
drainage; liver abscess; spontaneous rupture; surgery