PYOGENIC AND AMOEBIC LIVER ABSCESSES - SASSiT

PYOGENIC AND AMOEBIC 

LIVER ABSCESSES 

S.C TSOTETSI 

Gesondheidswetenskappe Onderwys • Health Sciences Education 

UNIVERSITEIT VAN DIE VRYSTAAT • UNIVERSITY OF THE FREE STATE • YUNIVESITHI YA FREISTATA 

Tel (051) 401 3000 • E-mail: info@ufs.ac.za • www.ufs.ac.za

AETIOLOGY (Pyogenic liver 

abscess) 

• BILE DUCTS CAUSING ASCENDING 

CHOLANGITIS 

• PORTAL VEIN, CAUSING PYLEPHLEBITIS 

• DIRECT EXTENSION 

• TRAUMA 

• HEPATIC ARTERY 

• CRYPTOGENIC 




AMOEBIC LIVER ABSCESS 

• ENTAMOEBA HYSTOLOTICA 

• FOUND MOSTLY IN TROPICAL AND SUBTROPICAL 

COUNTRIES 

• HAS TWO FORMS, TROPHOZOITE AND CYST 

• TROPHOZOIT STAGES LIVE IN THE COLONIC MUCOSA 

• REPRODUCTION IS BY BINARY FISSION 

• INFECTION BY CONTAMINATED FOOD 

• SYMPTOMS USUALLY LIMITED TO THE GIT 

• HAEMATOGENOUS SPREAD CAN RESULT IN LIVER 

ABSCESSES – LIVER CELLS UNDERGO LIQUEFACTION 

NECROSIS TO PRODUCE A CAVITY FILLED WITH BLOOD 

AND LIQUEFIED LIVER TISSUE 




FEATURES OF AMOEBIC vs 

PYOGENIC LIVER ABSCESS 

CLINICAL FEATURES AMOEBIC ABSCESS PYOGENIC ABSCESS 

AGE (yr) 20 - 40 > 50 

Male: female ratio ≥ 10 ; 1 1.5 :1 

Solitary vs. multiple Solitary ≥ 80% Solitary 50% 

Location Usually right liver Usually right liver 

Travel in endemic area Yes No 

Diabetes Uncommon More common 

Alcohol use Yes Yes 

Jaundice Rare Common 

Elevated alkaline 

phosphatase 



Tel (051) 401 3000 • E-mail: info@ufs.ac.za • www.ufs.ac.za 

Common 

Common 

Positive blood culture No Common 

Positive amoebic 

serology 

Yes 

No

DIAGNOSIS 

• CAN’T DIFFERENTIATE BETWEEN 

PYOGENIC AND AMOEBIC LIVER 

ABSCESS RADIOLOGICALLY 

• SEROLOGY CONFIRMS Dx IN AMOEBIC 

ABSCESSES 

• NB: ENDEMIC AREAS 

• EXCLUDE COMPLICATED HYDATID 




TREATMENT 

• AMOEBIC ABSCESS – ANTIBIOTICS 

• SURGICAL INDICATION FOR AMOEBIC ABSCESS 

- IMMENENT CYST RUPTURE 

- NO RESPONSE TO ANTIBIOTIC THERAPY 

- TIMELY EXCLUSION OF OTHER Dx NEEDED 

• PYOGENIC LIVER ABSCESSES – DRAINAGE + 

ANTIBIOTICS 

- OPEN 

- PERCUTANEOUS - NEEDLE ASPIRATION 

- CATHER 

- LOOK FOR THE CAUSE !!! 




OPEN SURGICAL vs. PERCUTANEOUS 

DRAINAGE – PYOGENIC ABSCESSES 

• Multiple abscesses 

• Loculated abscesses 

• Abscess with viscous 

contents obstructing 

catheter 

• Underlying disease 

requiring surgery 

• Inadequate response to 

percutaneous drainage 




SURGICAL vs. PECUTANEOUS 

DRAINAGE FOR PYOGENIC LIVER 

ABSCESSES LARGER THAN 5CM 

• SURGERY HAS LESS TRATMENT FAILURES 

• LESS REQUIREMENT FOR SECONDARY 

PROCEDURES 

• SHORTER LENGTH OF HOSPITAL STAY 

• NO DIFFERENCE IN MORBIDITY OR MORTALITY 

Ann surg 2005;241 : 485 - 490 




PERCUTANEOUS HEPATIC ABSCESS 

DRAINAGE: DO MULTIPLE ABSCESSES OR 

MULTILOCULATED ABSCESSES PRECLUDE DRAINAGE 

OR AFFECT OUTCOME ? 

PERCUTANEOUS DRAINAGE IS A SAFE AND 

EFFECTIVE PROCEDURE IN THE TREATMENT OF 

PYOGENIC LIVER ABSCESSES, REGARDLESS OF 

ABSCESS COMPLEXITY AND/OR MULTIPLICITY 

J Vasc Interv Radiol 2009; 20:1059-1065 




ROLE OF ENDOSCOPIC THERAPY IN 

PYOGENIC LIVER ABSCESSES 

• ERCP IS THE BEST IMAGING PROCEDURE TO 

DIAGNOSE A COMMUNICATION BETWEEN THE 

BILIARY TREE AND A LIVER ABSCESS 

• ENDOSCOPIC INTERNAL DRAINAGE OF 

COMMUNICATING ABSCESS IS FEASIBLE AND 

SAFE 

• FINAL PROGNOSIS DEPENDS ON 

UNDERLYING DISEASE 

• Am J Gastroenterol 2007;102:1209-1215 




COMPLICATED AMOEBIC 

LIVER ABSCESSES 

• COMMUNICATION OR EXTENSION 

PERITONEUM 

VISCERA 

LARGE VESSELS 

PLEURA, BRONCHI AND LUNGS 

PERICARDIUM 

• UNLESS SECONDARILY INFECTED, TREAMENT 

CONSTITUDES DRAINAGE 




CONCLUSION 

• CORRECT DIAGNOSIS 

• EXCLUDE COMPLICATED HYDATID CYST 

• AMOEBIC LIVER ABSCESS – MEDICAL 

• PYOGENIC LIVER ABSCESS – DRAINAGE + 

ANTIBIOTICS 

• PROGNOSIS IN PYOGENIC LIVER ABSCESS 

DEPENDS ON THE UNDERLYING CONDITION

PYOGENIC AND AMOEBIC LIVER ABSCESSES - SASSiT

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