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Vol. 70. Núm. 3.
Páginas 164-172 (Septiembre 2001)
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Vol. 70. Núm. 3.
Páginas 164-172 (Septiembre 2001)
DOI: 10.1016/S0009-739X(01)71869-6
Acceso a texto completo
Abscesos hepáticos piógenos
Pyogenic liver abscesses
Visitas
...
J.A. Álvarez Pérez1, R.F. Baldonedo Cernuda
Servicio de Cirugía General. Hospital San Agustín. Avilés
J.J. González González*, L. Sanz Álvarez*
* Servicio de Cirugía General B. Hospital Central Universitario. Universidad de Oviedo
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Resumen

El absceso hepático piógeno es una enfermedad que sigue siendo aún un reto médico, ya que su curso clínico suele ser grave, el diagnóstico, en ocasiones, es tardío y la mortalidad elevada. En las últimas décadas, han existido diversos avances, como la introducción de los antibióticos y el desarrollo de técnicas radiológicas (ecografía y TC) que han mejorado la eficacia diagnóstica y posibilitado el drenaje percutáneo de los abscesos. Ambas circunstancias, unidas al perfeccionamiento en el manejo de los enfermos graves, han condicionado que la tasa de mortalidad haya disminuido ostensiblemente, oscilando entre el 10 y el 30%; no obstante, el porcentaje de complicaciones es todavía demasiado elevado (30-60%).

En este artículo se realiza un estudio actualizado de los diferentes aspectos clínicos, terapéuticos y evolutivos que caracterizan a los pacientes con esta enfermedad. Entre ellos, cabe resaltar que el origen predominante de los abscesos piógenos se localiza en el árbol biliar; los aerobios gramnegativos son los gérmenes más comúnmente aislados, sobre todo E. coli, aunque cada vez es más frecuente la identificación de grampositivos, como Streptococcus milleri; la ecografía y la TC son los métodos diagnósticos de elección; las técnicas percutáneas, la aspiración y el catéter drenaje han relegado a un segundo plano al drenaje quirúrgico como principal forma de tratamiento. En el estudio también se analizan diversos factores de riesgo descritos en la bibliografía.

Palabras clave:
Absceso hepático piógeno
Etiopatogenia
Diagnóstico
Tratamiento
Mortalidad

Pyogenic liver abscess is still considered to be a medical challenge due to the seriousness of the clinical course, diagnosis, sometimes, late and mortality usually high. In the last decades there have been several advances such as the introduction of antibiotics, and the development of radiologic techniques (ultrasonography and CT) that have improved diagnostic accuracy and have made possible the percutaneous drainage of abscesses. Both circunmstances, thogheter with an improvement in the management of seriously ill patients, had clearly decreased the mortality rate, ranging at present 10-30%. However, the complication rate is still very high (30-60%). In this article, it is described an update study of the different outcome, therapeutic, and clinical aspects which distinguish patients with this disease. The most outstanding aspects are a biliary predominant origin of the abscesses; Gram-negatives aerobes are most commonly isolated organisms, mainly E. coli, nevertheless a progressive identification of Gram-positives, such as Streptococcus milleri is found; ultrasonography and CT are the diagnostic methods of choice; percutaneous techniques, such as aspiration and catheter drainage, are relegated to second place to surgical drainage, as main form of therapy. In this study, different risk factors mentioned in the literature are also analyzed.

Key words:
Pyogenic liver abscess
Etiology
Diagnosis
Treatment
Mortality
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