Percutaneous management of multiple liver abscesses

Complex ruptured amebic liver abscesses: the role of percutaneous catheter drainage

The failure of medical therapy for amebic liver abscess may be followed by its perforation, a complication associated with high mortality. We assessed the role of percutaneous catheter drainage in management of the sequelae of ruptured amebic abscesses in 13 critically ill patients; 22 intrahepatic lesions, three of which were multiloculated, were drained. Catheters were also placed in 17 extrahepatic collections: pleural space (n = 5), subphrenic (n = 7), perihepatic/subhepatic (n = 3), greater sac of peritoneum (n = 2). No attempt at percutaneous drainage failed. Prompt resolution of clinical features following drainage was a uniform feature. Successful resolution of the abscesses occurred within 20 days in 11 patients. In the remaining two, catheters needed to be retained in situ for 35 and 50 days. The mean hospital stay was 15 days (range 10-20 days). 100% patient survival was achieved, without a single morbid episode. Our results suggest that patients with ruptured amebic abscesses can be effectively and safely managed by percutaneous catheter drainage irrespective of the extent of extrahepatic contamination.

Hepatic abscess. Changes in etiology, diagnosis, and management

Most recent reviews of pyogenic hepatic abscess emphasize percutaneous versus open surgical management and devote little time to studying the etiology or the clinical condition of the patient. In this study a detailed review was performed with a computerized analysis of multiple clinical parameters in 73 patients treated for pyogenic hepatic abscess during a 17-year period. The mean age of the patients was 55 years and 38 of them (52%) were male. The mortality rate was comparable for solitary (17%) and multiple (23%) abscesses. The likelihood of death was higher with antibiotic treatment alone (45%) or percutaneous treatment (25%) than with surgical treatment (9.5%). The primary determinant of outcome, however, was the underlying disease, i.e., malignancy or an immunocompromised patient, rather than solitary versus multiple abscesses. In addition the incidence of hepatic abscess seen at this center has doubled from the first half to the second half of the review, reflecting a population of more severely ill patients. It is apparent that in current clinical practice several methods of management are effective, and the choice of therapy should be determined by individualized selection. The principle of timely diagnosis and prompt institution of treatment appropriate to the specific patient remains the standard of care in this potentially grave disease.

Ultrasound-guided percutaneous drainage of intra-abdominal abscesses

The encouraging results of percutaneous abscess drainage (PAD) in simple intra-abdominal abscesses have led us to employ this method in patients with more complex abdominal inflammatory disease, such as those with multiple enteric communicating or multilocular abscesses and patients in whom the percutaneous approach requires puncture routes traversing uninvolved organs. Cure was achieved in 74 per cent of all patients (83 of 112 patients) who underwent PAD, but in only 50 per cent of patients with multiple intra-abdominal abscesses (n = 16), 50 per cent of patients with complex pancreatic inflammatory disease (n = 8) and 57 per cent of patients with complex intraparenchymal abscesses (n = 7). PAD contributed to cure in eight of nine patients with enteric communicating abscesses. The transhepatic route to perihepatic abscesses proved to be safe. Complications occurred in nine patients (8 per cent). No relationship was noted between the severity or number of complications and the indication for PAD. Of the 29 failures of PAD, 17 patients were cured by either surgical intervention (14 patients) or a second PAD (1 patient) or a combination of the two methods (2 patients). Twelve patients (11 per cent) died, eight from sepsis due to inadequate drainage. Frequent reassessment by ultrasonography and computerized tomography (CT) in patients with prolonged sepsis after PAD is mandatory. These results justify a place for PAD in the management of the often critically ill patient with complex abdominal inflammatory disease.

Percutaneous drainage of hepatic abscesses in children

Ultrasound guided percutaneous drainage of seven hepatic abscesses in five pediatric patients was performed. Abscesses were pyogenic in four of the patients and amebic in one. All patients recovered completely without surgical intervention. Methodology necessary in the pediatric patient is stressed.

Percutaneous aspiration and catheter drainage of abscesses

Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.

Percutaneous abscess drainage

We have drained 50 abscesses in 40 patients. The success rate was 100% for entering the abscess cavities and 98% for establishing catheter drainage. The success rate for treating the abscess (i.e., no surgery required) was 88%. We drained all abscesses for which a safe access route was available, regardless of the abscess's characteristics. Abscesses which are not unilocular may be successfully treated by percutaneous drainage. In critically ill patients and those unsuitable for surgery, catheter drainage is useful until the patient becomes stable. When surgery is not feasible, percutaneous procedures may be the patient's only hope for survival.

Pyogenic liver abscess: diagnosis, bacteriology and treatment

Pyogenic liver abscess is an uncommon but potentially fatal disease. The accuracy of diagnosis made on clinical grounds can now be greatly improved with the use of modern organ-imaging techniques. The condition is often polymicrobial: Escherichia coli and other enteric gram-negative rods are major pathogens, with anaerobic gram-negative rods and Streptococcus milleri being increasingly recognised. Staphylococcal liver abscesses are less common, often arising in association with neutrophil disorders. Open surgical drainage along with antimicrobial chemotherapy has long been regarded as standard treatment, however, in many centres it is being displaced by percutaneous drainage under the guidance of computed tomography or ultrasound. Some patients have been successfully treated with antimicrobial chemotherapy alone. Once specimens have been taken for culture, empiric antimicrobial therapy should include a combination of an anti-anaerobe agent, an aminoglycoside and a beta-lactam drug such as ampicillin. Early diagnosis and treatment of this condition is essential for patient survival.