title: Hepatic abscess: Diagnosis and management.
abstract: Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity. Infection is usually bacterial, sometimes parasitic, or very rarely fungal. In the Western world, bacterial (pyogenic) HA is most prevalent; the mortality is high approaching 15%, due mostly to patient debilitation and persistence of the underlying cause. In South-East Asia and Africa, amebic infection is the most frequent cause. The etiologies of HA are multiple including lithiasic biliary disease (cholecystitis, cholangitis), intra-abdominal collections (appendicitis, sigmoid diverticulitis, Crohn's disease), and bile duct ischemia secondary to pancreatoduodenectomy, liver transplantation, interventional techniques (radio-frequency ablation, intra-arterial chemo-embolization), and/or liver trauma. More rarely, HA occurs in the wake of septicemia either on healthy or preexisting liver diseases (biliary cysts, hydatid cyst, cystic or necrotic metastases). The incidence of HA secondary to Klebsiella pneumoniae is increasing and can give rise to other distant septic metastases. The diagnosis of HA depends mainly on imaging (sonography and/or CT scan), with confirmation by needle aspiration for bacteriology studies. The therapeutic strategy consists of bactericidal antibiotics, adapted to the germs, sometimes in combination with percutaneous or surgical drainage, and control of the primary source. The presence of bile in the aspirate or drainage fluid attests to communication with the biliary tree and calls for biliary MRI looking for obstruction. When faced with HA, the attending physician should seek advice from a multi-specialty team including an interventional radiologist, a hepatobiliary surgeon and an infectious disease specialist. This should help to determine the origin and mechanisms responsible for the abscess, and to then propose the best appropriate treatment. The presence of chronic enteric biliary contamination (i.e., sphincterotomy, bilio-enterostomy) should be determined before performing radio-frequency ablation and/or chemo-embolization; substantial stenosis of the celiac trunk should be detected before performing pancreatoduodenectomy to help avoid iatrogenic HA.
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France.
authors.forename: S
authors.initials: S
authors.lastname: Lardière-Deguelte
authors.affiliation: Department of Hepatobiliopancreatic and Liver Transplantation, Beaujon Hospital, AP-HP, 92110 Clichy, France; Université Denis Diderot, Paris 7, 75013 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Ragot
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France.
authors.forename: K
authors.initials: K
authors.lastname: Amroun
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France.
authors.forename: T
authors.initials: T
authors.lastname: Piardi
authors.affiliation: Department of Hepatobiliopancreatic and Liver Transplantation, Beaujon Hospital, AP-HP, 92110 Clichy, France; Université Denis Diderot, Paris 7, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Université Denis Diderot, Paris 7, 75013 Paris, France; Department of Radiology, Beaujon Hospital, AP-HP, 92110 Clichy, France.
authors.forename: O
authors.initials: O
authors.lastname: Bruno
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France.
authors.forename: F
authors.initials: F
authors.lastname: Appere
authors.affiliation: Université Denis Diderot, Paris 7, 75013 Paris, France; Department of Radiology, Beaujon Hospital, AP-HP, 92110 Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Sibert
authors.affiliation: Department of Radiology, Robert-Debré Hospital, 51100 Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Hoeffel
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France.
authors.forename: D
authors.initials: D
authors.lastname: Sommacale
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré Hospital, Université de Reims Champagne-Ardenne, 51100 Reims, France. Electronic address: rkianmanesh@chu-reims.fr.
authors.forename: R
authors.initials: R
authors.lastname: Kianmanesh
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004322:Drainage; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Classification; Diagnosis; Etiology; Hepatic abscess; Management