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Invited Commentary

Thomas V. Berne, MD
Arch Surg. 1995;130(4):406. doi:10.1001/archsurg.1995.01430040068013.
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This report analyzed 424 pyogenic liver abscess cases. The importance of this report, in addition to contributing their experience with a large series of patients, is the authors' look at the importance of 83 cases that contained gas on either ultrasound or computed tomographic examination. Of clinical importance, they identified statistically higher incidences of septic shock, abscesses 5 cm or larger, cryptogenic origin, diabetes mellitus, Klebsiella pneumoniae cultures (blood and abscess), bacteremia, and mortality. This information clearly indicates that the presence of gas in a pyogenic liver abscess has important prognostic implications, despite a previous report by this group,1 when their series was only slightly smaller (352 cases), that did not find gas-forming abscesses as an "independent factor" in regard to mortality. Less convincing is their apparent recommendation for more aggressive open operative drainage when a liver abscess contains gas. Most would agree with their general scheme for management,


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