Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies

Semin Liver Dis. 2018 Aug;38(3):270-283. doi: 10.1055/s-0038-1661363. Epub 2018 Jul 24.


Pyogenic liver abscess (PLA) of biliary origin in Southeast Asia mainly occurs in patients with intrahepatic bile duct stone (IBDS) and extrahepatic bile duct stone (EBDS), bilioenteric anastomosis, or biliary stent. IBDS, as an endemic to Southeast Asia, remains a frequent etiology of acute cholangitis and PLA. PLA related to IBDS is characterized by high incidences of PLA recurrence and death related to infection, and difficulties in diagnosis of concomitant cholangicarcinoma. PLA of biliary origin is more likely caused by Escherichia coli, more often presented as polymicrobial infections, and more associated with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolates. In this review, the authors summarize the differences on the presumed causes, pathogens, multidrug resistance, treatment, and prognosis of PLA between biliary origin and cryptogenic origin, the latter serving as a first and foremost presumed etiology of PLA. The authors also discuss the existing problems on early diagnosis of concomitant cholangicarcinoma related to IBDS.

Publication types

  • Review

MeSH terms

  • Asia / epidemiology
  • Bacteriological Techniques
  • Bile Duct Neoplasms / diagnosis
  • Bile Duct Neoplasms / epidemiology
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / therapy*
  • Biliary Tract Surgical Procedures / adverse effects
  • Biliary Tract Surgical Procedures / instrumentation
  • Biopsy
  • Cholangiocarcinoma / diagnosis
  • Cholangiocarcinoma / epidemiology
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / therapy*
  • Cholelithiasis / diagnosis
  • Cholelithiasis / epidemiology
  • Cholelithiasis / mortality
  • Cholelithiasis / therapy*
  • Humans
  • Liver Abscess, Pyogenic / diagnosis
  • Liver Abscess, Pyogenic / epidemiology
  • Liver Abscess, Pyogenic / microbiology
  • Liver Abscess, Pyogenic / therapy*
  • Predictive Value of Tests
  • Recurrence
  • Risk Factors
  • Stents / adverse effects
  • Tomography, X-Ray Computed
  • Treatment Outcome