The role of computerized tomographic scanning in the surgical management of pyogenic hepatic abscess

We reviewed all patients with hepatic abscesses treated at this hospital during a 34 month interval defined by the availability of computerized tomographic scanning to assess the impact of this imaging technique on preoperative and postoperative management. Computerized tomographic scan was obtained in eight of nine patients diagnosed antemortem and was crucial to the management of at least three of these. With the proviso that these recommendations are based upon preliminary experience and, therefore, subject to modification, we endorse the plan to be presented. A pyogenic hepatic abscess remains a surgical problem of considerable morbidity and mortality. The key to successful management is early diagnosis. Fever of unknown origin accompanied by any indication of liver disease - history, physical findings, laboratory tests - mandates consideration of liver abscess in the differential diagnosis. When an hepatic abscess is considered a diagnostic possibility in a patient in whom another space occupying hepatic lesion is known to exist or may be reasonably suspected, computerized tomographic scan of the liver must be performed. When a hepatic abscess is considered a diagnostic possibility in a patient in whom no grounds exist to suspect another space occupying lesion, computerized tomographic scan remains the diagnostic study of choice. A liver scan may be used if computerized tomographic scanning is unavailable. When an hepatic abscess is diagnosed, computerized tomographic scan must be obtained to define fully the number and location of abscess cavities. Serologic testing for amebiasis must be performed. Adequacy of management must be assessed. Medical management of an amebic hepatic abscess should be followed by serial computerized tomographic scans. Surgically drained abscesses may be monitored by sinogram; computerized tomographic scan remains the procedure of choice. Any post-therapeutic complication must be regarded as due to inadequate drainage or sequela until proved otherwise; a computerized tomographic scan done as an emergency measure is mandatory, followed promptly by operation if the scan reveals a recurrence of the disease.