Original article
Pyogenic liver abscess in the aged

https://doi.org/10.1016/S0002-9610(44)90267-9Get rights and content

Abstract

  • 1.

    1. Pyogenic liver abscess occurs rarely in the aged and is characterized by a high mortality.

  • 2.

    2. The pathogenesis of pyogenic liver abscess in individuals of advanced years is similar to that of hepatic infection in younger groups of patients. In the aged, however, the diagnosis is frequently rendered more difficult by the fact that these older patients react minimally to the disease process. In individuals past the fifth decade, the onset of the infection may be insidious, and the classical signs and symptoms of pyogenic liver abscess may be diminished or absent.

  • 3.

    3. In the aged, the indications for operative treatment of pyogenic liver abscess are the same as in younger individuals, and age alone must not be considered the determining factor when the advisability of operation is in question. The type of drainage operation performed, whether transperitoneal, transpleural, or extraserous, is determined by the situation of the lesion, as in younger patients. The peculiar susceptibility of older individuals to surgical shock, because of the likelihood of concomitant degenerative changes of a cardiorenal or nervous nature, should be kept in mind, however. Success in the handling of pyogenic liver abscess in the aged will only be attained by early diagnosis and careful preoperative and postoperative treatment. In these cases, a surgical technic of utmost gentleness should be employed, and all operative procedures should be carried out in the shortest period of time practicable.

  • 4.

    4. Two cases of pyogenic liver abscess in individuals of the seventh decade of life are presented. In one case a fatal infection was associated with a calcified echinococcic cyst of the dome of the liver. In the other, recovery followed abdominal drainage of an abscess caused by the rupture of an infected gallbladder into the liver parenchyma.

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