2). Finally, having controlled bleeding and checked for bile leakage, two gravity drains were placed in the residual cavity (6). Fig. 2 Intra-operative most findings: a) identification of the abscess; b) cleavage by blunt dissection; c) drainage; d) rupture of the septum and lavage with bactericidal solution. Results The postoperative course was regular: the patient began passing gas on day 2 and began eating. The drains were removed on day 7 and the patient was discharged the following day, with his clinical picture and laboratory parameters having fully normalized. Follow up US exams confirmed the disappearance of the lesion. Discussion Liver abscesses were recognized as far back as Hippocrates, in 400 BC, who thought that prognosis was related to the type of fluid in the lesion.

Osler, in 1890, was the first to describe the presence of amebae in a patient��s abscess and stools, but it was only in the early 20th century that amebae were correlated to the formation of a liver abscess. The etiology varies. In addition to pyogenic bacteria and amebae, other microorganisms, such as fungi and cytomegalovirus, can also cause liver abscesses, albeit rarely, especially in immunosuppressed patients. The most common causes of pyogenic abscesses are Escherichia coli, Klebsiella and Enterococcus. Among the anaerobic bacteria, Bacteroides, anaerobic streptococci and Fusobacterium predominate. Aerobic, anaerobic or microaerophilic streptococci are isolated in 25�C30% of cultures from liver abscesses (7). In the USA, the incidence of pyogenic abscesses is 8�C15 new cases/100,000 inhabitants/year, accounting for over 80% of cases.

Abscesses due to amebae make up 10% of cases, and are more common in tropical areas, in tourists and in immigrants from developing countries, while fungi and other agents are responsible for less than 10%. Abscesses due to pyogenic bacteria and amebae seem to be more common in men, with the incidence peaking between the ages of 40 and 60 years. Most pathogens reach the liver via the portal system. In normal conditions, the immune system of healthy subjects prevents the colonization of the sinusoids and parenchyma through intrahepatic elimination. Predisposing factors are thus necessary for a liver abscess to arise.

These include trauma, necrotic or hemorrhagic areas, tumors, obstruction and/or primary or secondary malignant stenosis of the bile ducts and/or portal branches, arterial microemboli in systemic sepsis, perfusion defects, iatrogenic cell necrosis after chemoembolization and post-transplant mini-microabscess (MMA) syndrome. However, distal Brefeldin_A abdominal infections are most commonly implicated. Dieulafoy coined the term la foie appendiculaire to describe a picture of multiple liver abscesses following perforated appendicitis, which is in fact one of the most common infectious foci. Other foci include cholecystitis, pylephlebitis, perihepatic and subphrenic abscesses, diverticulitis, IBD and pelvic sepsis (7).