Liver Abscess

Drainage of Pyogenic Liver Abscess

Intern 2003-12-22

Drainage
Until 1980s, surgical drainage Ultrasound / CT develop, image guided drainage of pyogenic liver abscess Most authorities prefer percutaneous drainage as primary therapy

When to surgical intervention

Usually reserved, use when 1.failed percutaneous draingae 2.concurrent intraabodominal disease 3.multiple large abscesses 4.ascites 5.severe bleeding diathesis

How to approach
1. Extraserous approach to avoid peritoneal contamination. 1938, Oschner and Debakey 2.Transperitoneal approach with improvement of antibiotics, decades later 3. Laparoscopic drainage, recently

What to do
Localization ( visually or echo ) Aspiration Core biopsy Irrigation Catheter placement for 5-7 days Resection when segment or lob destroyed

Aspiration to do
Gram stain Bacteria culture ( aerobic and anaerobic ) Microbiologic evaluation for Entamoeba histolytica, mycobacteria, fungi, others Histopathologic exam of biopsy

Outcome
McFadzean et al first reported 14 patients with successful treatment in 1953 Over the past 20 years, successful rate 69% to 90% Multiple abscess has lower successful rate than solitary abscess

Complications
Catheter dislodgement Bleeding Sepsis

Without Catheter Drainage

Success rate 58% to 88%, similar to catheter drainage

Amys Choice

Our patient, Amy, received liver resection, S7 S8 segmentetctomy, because of her large ,viscious abscess after ultrasound evaluation.

Conclusion

Pyogenic liver abscess under drainage is improving with the upgrading of technology.

Reference

Eric C. Johannsen, MD et al, Infections Disease Clinics of North America Vol 14, Num 3, September 2000 pp 547-563