Liver Abscess: Pyogenic and Amebic Hepatic Abscess

The two main types of liver abscesses are pyogenic and amebic. Recently, pyogenic liver abscesses have begun to be diagnosed much more commonly, and the majority result from biliary and intraabdominal infection. Amebic liver abscess is a complication of Entamoeba histolytica dysentery. The clinical presentation of both types of liver abscess is similar, and often vague and nonspecific, necessitating a high index of suspicion for prompt diagnosis and treatment. Ultrasonography and computed tomography (CT), along with culture and serology, correlated to clinical signs and symptoms, aid in establishing the diagnosis. Treatment of pyogenic liver abscess requires percutaneous drainage combined with antimicrobial therapy. Open surgical drainage is reserved for treatment failures or for patients requiring concomitant surgical treatment of an intraabdominal source. In contrast, amebic liver abscess responds well to amebicidal treatment and rarely requires drainage. Outcomes are largely dependent on the underlying cause and the severity of illness at presentation.