Q J Med 2002; 95: 797-802
© 2002 Association of Physicians
Liver abscess in adults: ten years experience in a UK centre
From the Guy's, King's and St Thomas' School of Medicine, King's College London, and 1 Department of Infection & Tropical Medicine, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
Received 12 December 2001 Accepted for publication 19 August 2002.
Background: The epidemiology and management of liver abscess (LA) have evolved over time.
Aim: To examine our experience over 10 years in a UK teaching centre.
Design: 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.
Discussion: 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.
Address correspondence to Dr A.H. Mohsen, Weston Education Centre, GKT School of Medicine, King's College, University of London, London SE5 9RJ. e-mail: Abdul.Mohsen{at}kcl.ac.uk
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