10417              MULTIPLE HEPATIC ABSCESSES (BACTEROIDES INFECTION)

The patient was a man aged 61 who had abdominal pain for 10 weeks mainly under the right costal margin, accompanied by jaundice, dark urine and pale faeces.  The liver was enlarged.  There was a leucocytosis of 33,000, 95% polymorphs.  Liver function tests: cephalin cholesterol +++, alkaline phosphatase raised.  In hospital the patient ran an intermittent fever.  Liver abscess was suspected and laparotomy was performed.  However liver biopsy was reported as non-specific and there was no growth on culture.  Circulatory failure developed and the patient died 3 days after the operation.  At postmortem there was diverticulitis in the sigmoid colon and multiple liver abscesses were found, together with pus in the lesser sac.  A large amount of bile stained fluid containing many flecks of fibrin was present in the peritoneal cavity.

The specimen is the liver sectioned to show multiple irregular abscesses mostly in the left lobe.  Some of the abscesses are encapsulated and there is evidence of recent extension through the capsules in some places.  The abscesses contain thick yellow pus.  The intervening liver substance is congested.  Culture grew a bacteroides and scanty coliform bacilli.  Histology shows frank abscesses with some fibrous encapsulation and evidence of recent extension.  Some smaller abscesses obviously lie in portal venous channels in the portal tracts.