Hepatic Abscess in Adults: Integrated Approach and Surgical Considerations

Hepatic abscesses are suppurated cavities caused by the invasion and multiplication of microorganisms within the liver parenchyma. This condition is relatively uncommon, with an estimated incidence of 2.3 to 3.6 cases per 100,000 people yearly. However, the incidence is higher in specific populations, such as patients with underlying liver disease, diabetes, or other immune-compromising conditions. The most common cause of liver abscesses is the spread of infection from other parts of the body, such as the biliary tract or gastrointestinal tract. Other causes include trauma to the liver, such as from a penetrating injury or surgery or the presence of a foreign body in the liver. Liver abscesses are broadly divided into two types: amoebic and pyogenic. The clinical presentation might vary, including fever, abdominal pain, nausea and vomiting, jaundice, and weight loss. In some cases, there may be no symptoms. Diagnosis typically involves an ultrasound or CT scan, which can show the presence of a fluid-filled mass in the liver. CT is the standard modality for diagnosis. Blood tests may also evaluate liver function and identify any underlying infections. Treatment typically involves a combination of antibiotics to target the underlying infection and drainage of the abscess. Supportive measures like hydration and pain management may also be necessary. In addition, close monitoring and follow-up are essential to ensure that the abscess has resolved and there are no complications. In some cases, surgical intervention may be necessary to remove the abscess or repair any damage to the liver. Liver abscess drainage is typically indicated in patients with significant, symptomatic abscesses or those who do not respond to medical treatment with antibiotics. In addition, abscesses at risk of rupturing or located close to vital structures, such as major blood vessels, may require drainage to prevent serious complications. Two drainage methods are presently available: non-surgical options, such as percutaneous needle aspiration or percutaneous catheter drainage, and surgical options, such as open drainage or laparoscopic drainage. This review identifies when these alternatives should be used, taking adverse effects, symptoms, and comorbidities into account.