Aetiology, diagnosis and treatment of hepatic abscesses after biliary tract surgery
Biliary Tract Diseases
Escherichia coli Infections
The majority of hepatic abscesses of biliary tract origin are the result of suppurative or non suppurative cholangitis, caused either by common duct stones, inflammatory stricture or malignancies. We report our experience of 7 consecutive liver abscesses after biliary tract surgery, treated in our surgical unit over a 2-year period, there were 6 females and 1 male with an age of 41 to 83 years. Hepatic abscess after biliary surgery developed from 10 days to 14 months postoperatively. Two patients underwent primary surgical drainage and remained clinically well 6 months and 2 years postoperatively. Five patients initially had percutaneous drainage and 4 of them subsequently underwent operative drainage; one patient declined any further operative treatment after percutaneous drainage and died 8 days later from continuing sepsis. Multiple factors may account for the development of both cholangitis and hepatic abscess following biliary tract procedures. Radiologic investigation should not only focus on the abscess itself but must also identify underlying biliary pathology. Our experience suggests that a surgical approach may be preferable to percutaneous techniques as it allows appropriate management of the associated biliary pathology.