Der pyogene Leberabszess: eine retrospektive Patientenstudie

Zusammenfassung

Einleitung: Der pyogene Leberabszess (PLA) ist eine Erkrankung, die sich in den letzten Jahrzehnten hinsichtlich ihrer Genese sowie der diagnostischen und therapeutischen Möglichkeiten verändert hat.

Material und Methodik: In dieser Studie wurden die letzten 20 Patienten, die mit der Hauptdiagnose eines PLA in einer gastroenterologischen Abteilung eines Universitätsklinikums behandelt wurden, retrospektiv analysiert. Dabei wurden die epidemiologischen, klinischen, mikrobiologischen und therapeutischen Aspekte ausgewertet.

Ergebnisse: 75 % der Patienten waren männlich. Das mittlere Erkrankungsalter lag bei 51,7 ± 16,6 Jahren. Die Genese des PLA war mit 70 % am häufigsten hepatobiliär; Hauptrisikofaktoren waren der Diabetes mellitus (25 %) und das Cholangiokarzinom (20 %). Bei mindestens einem Patienten kam ursächlich ein Morbus Crohn infrage. Die häufigsten Symptome waren Fieber (70 %) und Tachykardie (50 %), alle Patienten zeigten eine Erhöhung des C-reaktiven Proteins. In Abszesskulturen waren Enterokokken (> 40 %) und Anaerobier (> 20 %), in Blutkulturen Escherichia coli (25 %) die häufigsten Erreger.

Diskussion: Der PLA präsentiert sich klinisch oft unspezifisch, sodass die Erkrankung gerade bei Patienten mit typischen Risikofaktoren in die differenzialdiagnostischen Überlegungen eingeschlossen werden sollte. Insbesondere bei Patienten ohne Vorerkrankungen sollte der Diagnose eines PLA eine Suche zur Klärung der Genese folgen.

Abstract

Introduction: Pyogenic liver abscess (PLA) is a disease with changing origins as well as diagnostic and therapeutic options in the last decades.

Materials and Methods: A retrospective study of the last 20 patients treated at a gastroenterological department of a university clinic for the major diagnosis of PLA was conducted. Epidemiological, clinical, microbiological and therapeutic aspects were recorded.

Results: 75 % of the patients were male. The mean age was 51.7 ± 16.6 years. Most of PLA (70 %) had a hepatobiliary origin. Diabetes mellitus (25 %) and cholangiocarcinoma (20 %) were the major risk factors for PLA. Crohn’s disease was a possible cause in at least one patient. Fever (70 %) and tachycardia (50 %) were the most common symptoms. The C-reactive protein was elevated in all patients. Enterococci (> 40 %) and anaerobes (> 20 %) were the most frequent organisms in abscess cultures, Escherichia coli (25 %) was the most frequent organism in blood cultures.

Discussion: The clinical presentation of PLA is usually non-specific. Therefore especially with patients having typical risk factors the differential diagnosis of PLA should be considered. Particularly patients suffering from PLA without any pre-existing illness should be examined for an underlying disease.

Schlüsselwörter

Leberabszess - Pyogen - Morbus Crohn - Diabetes mellitus - Cholangiokarzinom

Key words

liver abscess - pyogenic - Crohn’s disease - diabetes mellitus - cholangiocarcinoma

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