Complex liver abscess

The morbidity and mortality of complex hepatic abscess has decreased greatly over the past 25-50 years. A diagnosis that once carried a high mortality is now treated with primarily antibiotic therapy and percutaneous drainage. Diagnosis can be made on the basis of right upper quadrant pain, fever, and leukocytosis. Computed tomography and/or ultrasound allow assessment of the size of the abscess and relationship to adjacent structures. Liver abscess can be broadly classified as pyogenic, amoebic, or fungal. Pyogenic sources are the most likely biliary or enteric in origin. Amebiasis remains the most prevalent in developing nations and those that travel to endemic regions. Fungal hepatic abscess is found in immunocompromised hosts, most commonly those undergoing chemotherapy. Major hepatic necrosis after angioembolization of the liver is another source of hepatic abscess and can be managed with resectional debridement or lobectomy. Though the majority of liver abscess can be managed with medical and percutaneous therapies, surgery is occasionally required and mandates full mobilization of the liver for adequate exposure of relevant anatomy.