Size Of Abscess Cavity Research Articles

A RANDOMIZED COMPARATIVE STUDY OF CONSERVATIVE VS PERCUTANEOUS NEEDLE ASPIRATION OF LIVER ABSCESS BASED ON PERCENTAGE OF ITS LIQUEFACTION.

Introduction:- Liver abscess is one of the common acute abdominal condition. Conservative management and percutaneous needle aspiration are the commonly used methods of management. But there is no common consensus between the physicians regarding best option out of these two. To Aim:- compare and to identify the better treatment modality among these two options for the treatment of liver abscess based on the percentage of liquefaction. A total of 140 patients with liver abscess were included in the study. T Patients and Methods:- hey were grouped in to Group A and B, based on percentage of liquefaction, they were further subdivided into conservative and aspiration subgroups and randomized. The outcomes of the two procedures were studied with respect to reduction in abscess cavity size, reduction in leukocyte count and patient's satisfaction. There was a signicant reduction in the ab Results:- scess size and leukocyte count in conservative subgroup of group-A, than conservative sub group of group B. Whereas there was signicant reduction abscess size and leucocyte count noted in aspiration sub group of Group B than aspiration sub group of Group A. Signicantly more number of the patients in conservative subgroup of group-A expressed their satisfaction, than conservative sub group of group B. Whereas signicantly more number of patients in aspiration sub group of the group B expressed their satisfaction than aspiration sub group of group A. present study concludes that conservative Conclusion:- treatment is also better option for liver abscess with 30-50% liquefaction, and aspiration is ideal for 50-70% liquefaction

STUDY OF ETIOLOGY OF LIVER ABSCESS AND IT'S DIFFERENT WAYS OF MANAGEMENT

Background: Liver abscess are cystic, space occupying lesion within liver parenchyma. It has become one of the most common disease with more prevalence in underdeveloped and developing countries. Pyogenic liver abscess more common in western world while amoebic liver abscess are more common in underdeveloped countries and people living with lower socio-economic conditions. Liver abscess, undiagnosed and untreated, has a very high mortality rate. With early diagnosis and prompt institution of specic therapy, the prognosis is good and the mortality is very low. Surgical management was the mainstay for treating liver abscess earlier. However, USG guided percutaneous needle aspiration and percutaneous drainage procedure shown a favorable outcome with less average length of stay in hospital. In this study we aimed to study etiology of liver abscess and its different ways of management. To study the etiology of liver abscess Aim: Materials And Methods: and its different ways of management. This is a prospective, observational study was conducted in GSVM Medical College, LLR & Associated Hospitals, Kanpur (UP).Study was done on 100 patients with different types of liver abscess. Patient with ruptured liver abscess were not included. Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); relieving of symptoms and length of stay in hospital. Results: Out of 100 patients majority of patients were in the age range of 31-45 (56.0%) followed by 46-60 (22.0%) with mean age of 40.74±10.53 years. Most of the cases were males (98%), and females (2.0%). Majority of patients were with lower socioeconomic status (96%). Most of the patient having amoebic liver abscess (66%) with positive ELISA for antibodies, while 34 % of patient having pyogenic liver abscess with 10% having bacterial growth on culture examination having E.coli . 84% of cases having liver abscess in right lobe and were single (66.0%). On the basis of their personal history, comorbidities and clinical features, 14.05 were diabetic, 44.0% were alcoholic, 98% were having fever with 60% cases have chills and rigor and 100% having pain in right upper quadrant. Majority of cases undergone pigt Conclusion: ail treatment were pyogenic (76.4%) and majority of amoebic abscess were treated with aspiration (72.7%) and difference was found statistically signicant with p value of 0.001. Reduction in size of abscess cavity was observed in all the cases but recurrence was higher in conservative treatment (p=0.007) and length of stay was higher in pigtail (p<0.001).

Unusual presentation and outcomes of bilateral brain abscess in adult: a case report

Background: Brain abscesses are rare but serious infections caused by bacteria or fungi in the brain tissue. They can cause serious problems if not treated quickly, so it is important to find the problem and treat it as soon as possible. Case Presentation: A 46-year-old Saudi male heavy smoker presented to the emergency department with a 3-day history of dry cough, sore throat, subjective fever, malaise, and generalized body pain. Three pneumonia hospitalizations and a bronchoscopy confused the patient upon admission. The patient had a Glasgow Coma Scale of 14/15 and a mild right pronator drift. Brain imaging showed bilateral frontal intra-axial space-occupying lesions. Escherichia coli and Staphylococcus aureus, sensitive to amoxicillin and clavulanic acid, grew together in culture. At 1-month follow-up, the patient had fully recovered. Peripheral enhancement reduced abscess cavity size on a repeat computed tomography-brain. The patient showed no neurological deficits at his 3- and 6-month clinic visits. Long-term antibiotics were recommended for 6 months. Conclusion: A 46-year-old Saudi man with bilateral brain abscesses shows the importance of early diagnosis and treatment. Imaging and culture results helped diagnose and treat. Aspirating the cystic lesions and the patient's recovery prove the treatment's efficacy.

Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: an updated systematic review and meta-analysis.

Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD). A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software. Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR=1.23; 95% CI [1.12, 1.36], P< 0.00001), time for achieving 50% reduction of cavity size (MD=-2.32; 95% CI [-3.07, -1.57], P< 0.00001), and time for clinical improvement (MD=-1.92; 95% CI [-2.55, -1.28], P< 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P= 0.36, P= 0.06 and P= 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P= 0.39). PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.

COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS PIGTAIL CATHETER DRAINAGE FOR SOLITARY LIVER ABSCESS.

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Study on therapeutic effectiveness of laparoscopic drainage and image guided pigtail catheter drainage in the treatment of liver abscess: a randomised controlled trial

Background: Liver abscess is one of the major diseases of gastrointestinal system. A liver abscess is a suppurative cavity in the liver resulting from the invasion and multiplication of microorganisms, entering directly from an injury through the blood vessels or by the way of the biliary ductal system. Liver abscesses are most commonly due to pyogenic, amoebic or mixed infections.Methods: This is a randomised controlled trial to compare the outcomes of image guided pigtail catheter drainage and laparoscopic drainage in treatment of liver abscess. A total of 60 patients were recruited for the study and were divided into two groups between March 2017 to August 2018 with a follow up period of 6 months.Results: Mean average pain score were significantly higher in image guided pigtail drainage group than in laparoscopic drainage group on 2nd, 5th and 7th day. The time taken for more than 50% resolution and for total resolution of abscess cavity size in the laparoscopic drainage group is significantly less than the time taken by the pigtail drainage group (p value &lt;0.001). The average duration of hospital stay with pigtail catheter drainage is significantly higher (14.5±2.03) than the average duration of hospital stays with laparoscopic drainage (8.07±0.78).Conclusions: We conclude that laparoscopic drainage of liver abscess is superior to image guided pigtail catheter drainage in terms of post-operative pain, hospital stay post procedure and resolution of abscess cavity.

USG guided pigtail catheter placement for drainage of liver abscess as a minimally invasive procedure

Background: The objective of the study was to evaluate the advantages of USG guided pigtail catheter placement for drainage of liver abscess as a minimally invasive procedure.Methods: This is a retrospective study conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, April 2017 to August 2017. It included 45 patients who were diagnosed with solitary liquefied liver abscess. The effectiveness of drainage was determined by doing serial USG scans.Results: Age group varied from 27 to 52 years. Out of 45 patients 41 were men and 4 were women. The male to female ratio was 10:1. All the patients underwent USG guided pigtail catheter insertion for solitary liver abscess. Average hospital stay varied from 2–3 days. No complications were observed during the procedure.Conclusions: This study concludes that drainage of solitary liver abscess by USG guided pigtail placement as a minimally invasive procedure was good in clinically improving the patient’s general condition &amp; decreasing the size of abscess cavity.

Liver abscess: An observational study of clinical presentation and its management

Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. However, different modalities of treatment of liver abscess are conservative (medical management), percutaneous needle aspiration, percutaneous catheter drainage, surgical drainage and endoscopic drainage. The aim of the study is to evaluate the clinical presentation and the different management done for liver abscess. This is an observational prospective study for presentation of liver abscess and its management done in the department of general surgery, simmer hospital, Surat, Gujarat, India from 1st January 2018 to 31st December 2018. In this study, 35patients (23 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic 08; pyogenic 27) underwent either percutaneous needle aspiration, percutaneous catheter drainage, or surgical intervention along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge spinal needle under local anaesthesia was used to aspirate the abscess cavity. For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. Patients were followed up to assess the outcome of the treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization in cases of percutaneous needle aspiration and percutaneous catheter drainage. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved. Improvement in clinical features, liver function tests, ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Percutaneous Needle Aspiration versus Catheter Drainage in Treating Hepatic Abscess

Aim of the study: was to investigate the effectiveness of Percutaneous Needle Aspiration in comparison to continuous catheter drainage in the treatment of hepatic abscesses. Methods: A review of the scientific literature (From 1980 to October 2017) MEDLINE, EMBASE, SCOPUS, Current Contents, Cochrane Library, and Clinicaltrials.gov were searched to identify randomized controlled trials that investigated thoroughly the Percutaneous Needle Aspiration Versus Catheter Drainage in the treating of hepatic abscess and clearly met the inclusion criteria and the study primary endpoints (success rate, total resolution and mortality). Identification of papers and data extraction were performed by independent researchers. Results: the search yielded six eligible RCTs covering 348 patients. The meta-analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of success rate (RR: 0.79, 95% CI=0.64–0.97; P = 0.04), days to achieve a 50% reduction in abscess cavity size (SMD: −1.076, 95% CI 0.63–1.51; P < 0.00001) and overall clinical improvement (SMD: 0.71, 95% CI 0.35–1.09; P =0.0001). On the other hand, no significant difference was notable in the duration of hospitalization (SMD: −0.15, 95% CI −2.03 to 1.72, P = 0.84) or procedure-related complications (RR: 0.48, 95% CI 0.13–2.58; P = 0.39). Conclusion: The results of the present meta-analysis and systematic review indicated that PCD and PNA can be less safe and less invasive methods for the treatment of hepatic abscesses yet PCD is suggested to be more advantageous and superior to PNA.

Treatment of liver abscesses: A prospective randomized trial

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a prospective randomized comparative study of 60 patients, presented in outpatient and emergency department at the hospital, randomized equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Independent t-test was used to analyze these parameters. Results: The success rate was significantly better in catheter drainage group (P=0.006). The patients in pigtail catheter drainage group showed earlier clinical improvement (P=0.039) and 50% decrease in abscess cavity volume (P=0.000) as compared to those who underwent percutaneous needle aspiration. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Clinical Profile and Evaluation of Various Therapeutic Measures in the Management of Liver Abscess

Background: Liver abscess (LA) is defined as collection of purulent material in liver parenchyma, which can be due to bacterial, parasitic, fungal, or mixed infection. As amoebic liver abscess and pyogenic liver abscess are commonly encountered in Indian subcontinent and there are various management options available like conservative management, US/CT guided aspiration/catheter drainage, or surgical drainage without definite guidelines. Recently, there is increase in radiological guided aspiration/catheter drainage of liver abscess, but in some cases it is not even required and in others there is incomplete evacuation of the abscess finally requiring surgery. Hence, we have evaluated the various therapeutic approaches in the management of liver abscess. Aims and Objectives: To study clinico-pathological profile of liver abscess and to evaluate different therapeutic approaches in the management of liver abscess. Materials and Methods: This is an observational study of 65 patients, presented in outpatient and emergency department. The clinical profile of these patients was studied. The patients underwent conservative management/Needle aspiration/Catheter Drainage/Surgical treatment depending on the size of the abscess cavity. The effectiveness of either treatment was measured in terms of a decrease in the pain score, duration of hospital stay, a decrease in the TLC count, 50% reduction in abscess cavity size, and the time taken for effervescence of fever. Independent t-test and Chi-square test were used to analyze these parameters. Results: A significant improvement was seen in the patients of both ALA and PLA who underwent catheter drainage as compared to other modalities of treatment, which were used in this study. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Liver abscess: catheter drainage v/s needle aspiration

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a comparative study of 121 patients, presented in outpatient and emergency department at the hospital, randomized double blind trial was done and divide into two groups (percutaneous needle aspiration and pigtail catheter drainage.) about which surgeon did not knew about the division it was marked by evaluator. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, reduction in abscess cavity size and total/near total resolution of abscess cavity. Results: The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Percutaneous Drainage of a Diverticular Abscess Should be Limited to Two Attempts for a Resilient Diverticular Abscess

Management of a resilient diverticular abscess poses a big challenge. Currently there are no guidelines for the number of percutaneous drainages to be performed in resilient diverticular abscesses before attempting surgery. All patients (n = 117) who presented with a computed tomography scan-proven diverticular abscess from July 2008 to June 2011 were studied. They were divided into four groups based on the number of percutaneous drainages they underwent for their diverticular abscess: six patients underwent three or more drainages, nine patients underwent two drainages, 27 patients had one drainage, and 75 patients had no drainage. Readjustment, flushing, and upgrading size of the drain were not considered as separate drainage procedures. The size of abscess cavity was significantly higher for the patients who had three or more drainages (mean 8 cm, P < 0.001). A Hartmann's procedure was performed in the majority of patients in the three or more drainage group (83%) but in decreasing frequency as the number of drainages performed dropped: two drainage group (44%), one drainage group (15%), and no drainage group (19%). There was a significantly higher preoperative hospital stay for drainage and antibiotics in the patients from the three or more drainage group (P < 0.001). Patients with a resilient diverticular abscess are very likely to undergo a Hartmann's procedure after two attempted drainages. By performing additional percutaneous drainages in an attempt to avoid ostomy, patients are at an increased risk of sepsis and peritonitis with prolonged antibiotics and increased healthcare costs. We recommend limiting percutaneous drainage procedures to two attempts to cool down a resilient diverticular abscess before definitive surgery.

English

OBJECTIVE: The purpose of the study was to find out the role of ultrasonography in management of amoebic liver abscess. In this area, the simplest method for diagnosis and to determine the effectiveness of treatment proved by disappearance of symptoms and regression in the size of abscess cavity. METHODS: We studied prospectively 48cases of suspected liver abscesses admitted to our institute over 3years (February 2011 to February 2014). Daily follow up of patients was carried out in hospital for at least 10days. Patients were later followed up by ultrasound after discharge. RESULTS: We found the clinical features of the disease similar to those mentioned in essential text books of medicine, except that pain is not always epigastric while fever may be absent and hepatomegaly is not marked. Ultrasound is a simple, cheap diagnostic test, which is available. Metronidazole is an effective treatment and five of the patients required invasive method for diagnosis or treatment. CONCLUSION: Amoebic liver abscess if untreated is a serious disease. We concluded that recognizing the disease clinically and proving it by ultrasound is the main method for diagnostic confirmation.

Combined Endoscopic Transanal Vacuum-Assisted Rectal Drainage: A Novel Therapy for Colorectal Anastomotic Leak after TME for Cancer

Introduction: Low colorectal and colo-anal anastomosis leakage after anterior resection of rectum occurs in up to 24% of cases. Leak is the main cause of morbidity and mortality in postoperative period and can result in a permanent stoma in up to 25% of cases. Loop ileostomy or colostomy does not reduce the percentage of fistulas, but reduces flow rate. Conservative management imply long times to heal. Endosponge® system (B. Braun Aesculap AG, Germany) was recently acquired in clinical practice. This system accelerates healing process through vacuum creation, removal of fluids and edema, infection control, local increase of blood flow and stimulation of granulation tissue formation. The device consists of a cylindrical polyurethane sponge, with 400 to 600 micron pores, standard dimension of 7 cm, which can be cut to fit the estimated size of the abscess cavity. The drain tube is connected to a Redyrob Trans Plus®bottle which exerts a constant suction during the therapy. Materials and Methods: From November 2012 and March 2014 four patients were treated with Endosponge® system, all of them underwent operation of anterior resection of rectum for cancer and developed anastomotic leakage during postoperative course. All patients had loop ileostomy, none presented signs of sepsis. The Endosponge® system was then placed endoscopically. In all cases, after the first placing, the authors utilized sterile foam dressing from negative pressure wound therapy kit, tailored to better fill the abscess cavity and connected with Redyrob Trans Plus?bottle. Device changes were performed every 5 - 7 days, according to the size of the cavity and the amount of secretions produced. The treatment was started during hospitalization first and then continued as outpatient. Results: There was no mortality. The amount of secretions was related to the initial size and the degree of contamination of the abscess cavity. Antibiotic therapy was discontinued after an average of 21 days, with a range between 14 and 32 days. Complete healing was achieved in a median of 82 days (30 to 148) in all patients with good functional results, no further surgery was required. Conclusions: The results of therapy with Endosponge® seem encouraging. Success of therapy is higher if initiated as soon possible after the intervention and is also related to the size of dehiscence and abscess cavity. In cases with large abscesses, it is not clear whether this new treatment leads to reduction in healing time, however, can prevent the packaging of a (often definitive) colostomy. Further studies will be able to select patients who will most benefit from the procedure.