A pyogenic liver abscess (PLA) is a pocket of pus that forms in the liver in response to an infection or trauma. Pus is a fluid composed of white blood cells, dead cells, and bacteria that forms when your body fights off infection. In the case of PLA, instead of draining from the infection site, the pus collects in the liver. An abscess is usually accompanied by swelling and inflammation in the surrounding area. It can cause pain and swelling in the abdomen.
A pyogenic liver abscess can be fatal if it’s not treated promptly.
The most common cause of PLA is biliary disease. This is a broad term for conditions affecting the liver, pancreas, and gallbladder. An inflamed gallbladder is the most common cause for PLA out of all the biliary diseases.
Other causes include:
- bacteria from a ruptured appendix that forms an abscess
- pancreatic cancer
- colon cancer
- inflammatory bowel disease, such as diverticulitis or a perforated bowel
- a blood infection, or septicemia
- trauma to the liver by accident or injury
According to research published in the Clinical Infectious Diseases (CID), people with diabetes are at 3.6 times the risk for this condition because they’re often more susceptible to infection.
PLA symptoms resemble those of gallbladder inflammation or massive infection. They may include:
- right upper abdominal pain
- sudden dramatic weight loss, such as 10 pounds in a few weeks
- dark-colored urine
- whitish or clay-colored stool
Your doctor may order a combination of blood cultures and imaging tests to diagnose the condition. The following tests may be used:
- a CT scan to locate the abscess
- a CT scan with intravenous contrast, or injected dye, to find and measure the abscess
- blood tests to look for signs of an infection, such as an increased white blood count and high neutrophil level
- blood cultures for bacteria to identify the bacteria and determine which antibiotic you need
- an abdominal ultrasound to check for an abscess in the right upper quadrant
A pyogenic liver abscess may appear as a mass on the liver when viewed with CT scans.
Some people can be successfully treated for PLA with antibiotics alone. Most, however, need drainage of the abscess. This involves inserting a needle or tube into the abscess and removing the pus. Your doctor may also perform a liver biopsy at the same time by taking a sample of your liver. This helps your doctor determine the overall health of your liver, and it’s performed with the aid of a CT scan.
Doctors try to treat PLA without surgery if possible to prevent the risk of bacteria spreading through the body. However, in more severe cases, surgery may be required to fully remove the abscess materials.
After surgery you’ll be treated with antibiotics for several weeks to avoid recurring infection. According to a review article in Clinical Liver Disease (CLD), both parenteral (injected or infused) and oral medications may be used to treat and manage PLA. An initial course of intravenous antibiotics aids healing. Several weeks of taking strong antibiotics by mouth can help you heal after you’ve had a post-surgical checkup.
The main complication of PLA is sepsis, which is a body-wide bacterial infection that causes inflammation and a dangerous drop in blood pressure. If it’s not treated promptly with antibiotics, sepsis can be fatal.
PLA drainage and surgery have a risk of spreading bacteria throughout your body. This may cause widespread infection or the formation of abscesses in other organs.
Bacteria released and spread throughout the body can cause:
- septic pulmonary embolism when a bacteria stimulates a clot in one or more arteries in the lungs
- brain abscess, which causes permanent neurological damage
- endophthalmitis, which is an infection in the inner part of the eye that may lead to vision loss
PLA can be life-threatening. You should seek medical help immediately if you have the symptoms of PLA to avoid serious health complications. Prompt diagnosis and surgical treatment are important for a positive outlook.