9.1 Pyogenic liver abscess 

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Presents as pain in the right hypochondrium with hectic fever.

A liver abscess is an accumulation of pus in a necrotic cavity of the liver. A pyogenic liver abscess is caused by bacteria that can reach the liver in different ways:

- from the portal area: appendicitis, diverticulitis;

- from the gallbladder or bile ducts: as in empyema of the gallbladder and cholangitis;

- from the arterial area: as in sepsis.

The causative germs are usually Escherichia coli or other classical intestinal bacteria. The diagnosis can be difficult because the symptoms are sometimes not very pronounced. Typical symptoms are: pain in the right hypochondrium; hectic fever with leukocytosis and toxic condition of the patient. Clinical examination reveals liver palpitations. Diagnosis is made by ultrasound or CT scan with intravenous contrast, hemocultures, or ultrasound or CT-guided puncture with culture. Treatment consists of broad-spectrum antibiotics. If the patient remains highly toxic, percutaneous ultrasound or CT-guided puncture and drainage is indicated. Surgical drainage of a liver abscess is rarely necessary.

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