The Changing Clinical Pattern of Hepatic Abscesses

Thirty-six patients with hepatic abscesses were investigated and divided into the following two groups: (1) those diagnosed prior to 1965 and (2) those diagnosed after the availability of hepatic scans. In both groups male patients predominated. The age of the patients steadily decreased with time. The introduction of effective photoscanning techniques was associated with a decrease in overall mortality from 83% to 23%. The incidence of cryptogenic abscesses, insignificant prior to 1965, rose to comprise 45% of all those pyogenic origin. The incidence of abscesses secondary to extrahepatic biliary duct disease has concomitantly decreased. Speculation is brought forward that cryptogenic abscesses are due to intrahepatic microembolism. The successful nonoperative management of amebic abscesses in two patients utilizes serial hepatic scanning, hemoagglutination studies, and treatment with metronidazole.