A liver abscess is a pus-filled cavity that forms inside the liver as a result of a bacterial, parasitic, or fungal infection, and may arise due to abdominal infections or direct injury. Although it is not common in developed countries, it is a serious condition that threatens the patient’s life if not diagnosed and treated early, and in some cases, antibiotic treatment is not enough, and liver abscess surgery becomes a necessity to save the patient and prevent complications such as sepsis or death.
What is a liver abscess?
A liver abscess is a pus-filled cavity that forms within the liver tissue as a result of infection, direct injury, or, in rare cases, leakage or contamination after abdominal or biliary surgery. Liver abscesses are usually categorized into two main types:
- Bacterial (pyogenic) abscess: Most common in developed countries, often caused by infections in the bile ducts or transmission of germs from the gastrointestinal tract through the portal vein, but can also be caused by blood-borne infections or traumatic injuries to the abdomen. Causative bacteria include Escherichia coli, Klebsiella, and Staphylococcus.
- Amoebic abscess: More common in hot and developing regions, it is caused by the Entamoeba histolytica parasite that is transmitted through contaminated food or water. This type mostly affects the right lobe of the liver (because the right lobe is more perfused than the left lobe), and is characterized by a brownish content that resembles a thick sauce in consistency and color.
When is liver abscess surgery indicated?
Liver abscess surgery is performed when less invasive methods, such as antibiotics or needle drainage, fail to treat the condition. Percutaneous drainage is the first treatment in most cases of pyogenic abscess and is performed under radiological guidance using local anesthesia. Reasons for surgery include a large or complex abscess or serious complications such as bleeding, abscess rupture, or sepsis. Surgery is also used to treat underlying comorbidities that require surgical intervention, such as colon abscesses or peritonitis. Surgery is postponed or severely restricted in unstable conditions such as trauma or multiple organ failure, and temporarily replaced with intensively supervised drainage.
How is liver abscess surgery performed?
Liver abscess surgery is performed in two main ways: Open surgery and laparoscopic surgery.
- Open surgery is performed under general anesthesia. The surgeon opens the abdomen to drain the abscess and examines the abdominal cavity for other abscesses or sources of infection. The operation usually takes between one and two hours, depending on the size, location, and complexity of the abscess.
- Laparoscopic surgery is also performed under general anesthesia and is considered less invasive, as it is performed through small incisions using a camera and precise surgical instruments. It allows for drainage of the abscess and exploration of the abdomen with fewer complications and faster recovery time, usually taking about an hour to an hour and a half.
In both methods, medical imaging techniques such as ultrasound or CT scans are used to precisely locate the abscess during the procedure and ensure complete drainage.
Risks and complications of liver abscess surgery
Liver abscess surgery comes with some risks and complications that you should be aware of. Most notably, bleeding during or after the operation, which may require additional intervention, and infections can occur at the surgical site or inside the abdomen, which requires antibiotic treatment. In some cases, the abscess itself may recur or leak bile from the liver tissue, in addition, some patients may suffer from liver or kidney failure as a result of severe infection or delayed diagnosis, especially in complex cases, and not as a direct result of the surgery itself, and to minimize these risks, the medical team is keen to implement all the necessary steps carefully during surgery and follow the patient continuously after surgery.
After liver abscess surgery
After liver abscess surgery, the patient usually needs a period of hospitalization that varies according to the state of health and the body’s response to treatment. During this period, the medical team monitors the state of health and administers appropriate treatment, including antibiotics to prevent infections. The diet depends on the patient’s ability to eat, with a focus on balanced nutrition to support recovery. Follow-up examinations, including imaging such as ultrasound or CT scans, are used to monitor the healing of the abscess and ensure it does not recur. Patients are often able to return to their normal lives gradually, with the need to adhere to the doctor’s instructions and continuous follow-up to ensure full recovery.
Can a liver abscess be prevented?
The risk of developing a liver abscess can be minimized by following preventive measures that include paying attention to personal hygiene and food safety, such as washing hands thoroughly, cleaning vegetables and fruits, and cooking meats adequately. It is also advisable to avoid consuming contaminated food or water.
Prevention and early treatment of gastrointestinal infections play an important role in preventing abscesses, along with monitoring patients with chronic diseases such as diabetes or bile duct issues, following safe sexual practices, especially in high-risk groups, and getting Hepatitis A and B vaccines (although the vaccine does not directly prevent liver abscess, it helps protect the liver from other diseases that increase susceptibility), and regular medical follow-up is especially important for those who have previously undergone abdominal surgery or have weakened immunity.
In conclusion, liver abscess surgery is a necessary procedure in some complex cases and can be life-saving when other treatments fail. Early diagnosis and adherence to the treatment plan minimize complications and increase the chances of recovery, and medical follow-up remains essential to prevent recurrence of the abscess.
Sources:
- eMedicine. (2024, September). Liver abscess: Practice essentials, pathophysiology, etiology. Medscape.
- Brunicardi, F. C., Andersen, D. K., Billiar, T. R., Dunn, D. L., Hunter, J. G., Matthews, J. B., Pollock, R. E. (Eds.). (2000). Schwartz’s Principles of Surgery (7th ed.). McGraw-Hill. In Liver abscess. In StatPearls.
