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Gas-forming pyogenic liver abscess: A world review
Ann Hepatobiliary Pancreat Surg 2018 Feb;22(1):11-8
Published online February 28, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Coeway Boulder Thng1, Yen Pin Tan2, and Vishal G Shelat2

1Yong Loo Lin School of Medicine, National University of Singapore, 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
Received September 3, 2017; Revised October 21, 2017; Accepted October 23, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Gas-forming pyogenic liver abscess (GFPLA) has an incidence of up to 30% of all pyogenic liver abscesses (PLA). GFPLA has higher mortality compared to non-GFPLA. Mere presence of gas within abscess may not determine clinical outcome. Hence it is important to study biologic characteristics that make GFPLA a distinct clinical entity. The aim of this study was to conduct a world review on GFPLA. 
Methods: We conducted literature searches in PubMed using the following MeSH terms: “gas forming” AND “Liver abscess, pyogenic”, “gas” AND “Liver abscess, pyogenic”, “gas” AND “Liver abscess”, “gas forming” AND “Liver abscess”. Thirteen case series including 313 GFPLA patients were included. Age, gender, diabetes mellitus (DM), bacteriology, underlying etiology, symptoms, investigations, operative indications, and mortality rates were tabulated. 
Results: GFPLA is often cryptogenic. There was no difference in age, gender, or symptomatology between GFPLA and non-GFPLA patients. DM was more common in patients with GFPLA compared to that in non-GFPLA patients (mean: 83.5% vs. 38.3%). Klebsiella pneumoniae is the most common causative pathogen. GFPLA has higher mortality compared to non-GFPLA (mean: 30.3% vs. 9%). Conclusions: GFPLA is associated with DM and monomicrobial Klebsiella pneumoniae infection. GFPLA has high mortality. It needs to be recognized as a distinct clinical entity. (Ann Hepatobiliary Pancreat Surg 2018;22:11-18)
Keywords : Gas-forming pyogenic liver abscess


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