Drainage Of Liver Abscess Research Articles

Percutaneous Debridement of Posttraumatic Infected Major Hepatic Necrosis

Although percutaneous drainage of liver abscesses has long been the standard of care, percutaneous drainage of infected necrotic liver tissue is usually used only to stabilize a patient’s condition in the setting of sepsis before surgical debridement is ultimately required, frequently in the form of a hepatic lobectomy. The present report describes three cases of curative percutaneous drainage and percutaneous debridement of posttraumatic infected major hepatic necrosis. Techniques used included catheter suction, lavage, and foreign body retrieval.

Epidemiology, Clinical Features and Outcome of Liver Abscess: A single Reference Center Experience in Qatar.

To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar. A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from January 1, 2009, to December 31, 2010. Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture. In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 (91%) males and six (9%) females and their mean age was 47.4 ± 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 (79%) patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients (38%). The mean duration of hospitalization was 13.6 ± 8.1 days; the mean duration of antibiotic therapy was 34.7 ± 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 ± 4.1 days, mean duration of therapy was 11.8 ± 2.1 days, and all patients were cured. Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical intervention was unnecessary in almost all the cases.

First 100 laparoscopic surgeries in a predominantly rural Nigerian population: a template for future growth.

Minimal access surgery has revolutionized surgery practice. Its proven advantages, such as reduced postoperative pain, early return to unrestricted activities, and better cosmesis, have become important drivers for its rapid development. In sub-Saharan Africa this development has been slow. The aim of the current study was to describe the challenges and outcomes of laparoscopic procedures in a public hospital that caters to a predominantly rural population. The first 100 patients who underwent laparoscopic procedure in the Department of Surgery at Federal Medical Centre, Owerri, Nigeria were retrospectively analyzed. Data were retrieved from the medical records department as well as the surgical theater procedure register. The focus of the study was on patient demographics, indication for surgery, procedure performed, length of hospital stay, and morbidity and mortality data. Staff training was done locally and abroad. Altogether, 100 patients had laparoscopic surgery in our general surgery unit from September 2007 through July 2013. The ages of the patients was 5-75 years (median 36.5 years). The three main procedures were cholecystectomy (36 %), diagnostic laparoscopy (29 %), and appendectomy (21 %). The other operations performed included liver abscess drainage (7 %), adhesiolysis (3 %), hernia repair (1 %), and Heller's myotomy (1 %). Four cases were converted to open surgery. There were no deaths. There were 14 grades I and II postoperative complications in nine patients. Our study suggests that basic laparoscopic procedures could be offered safely to our resource-poor rural population. It is a platform on which we can hopefully introduce advanced laparoscopic surgical operations.

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Liver abscess could be amoebic, pyogenic, infected hydated, traumatic or ascaridal. Amoebic liver abscess follows 1-2months after amoebic dysentery due to invasion of liver by Entamoeba Histolytica via portal circulation. The study was taken by considering the following aims and objectives: Evaluation of clinical symptoms and signs of liver abscess. To evaluate the best modality of management of liver abscess. To evaluate the common microbiological organism responsible for liver abscess. Evaluation of mortality of liver abscess and its survival rate. This study was carried out in the Department of Surgery, G.R. Medical College and J.A. Group of Hospitals, Gwalior between July 2006 to October 2007. Total of 73 cases of liver abscess were included in the study. From our study of liver abscess, it was concluded that if the diagnosis of the liver abscess was made early, the survival of patients was good. The modern day ultrasound and other non-invasive imaging techniques had greatly revolutionized the diagnosis of the liver abscess. Out of the different treatment modalities for the liver abscesses, the main stay of treatment in both amoebic and pyogenic liver abscesses was antibiotics with USG guided percutaneous needle aspiration. If abscess cavity was larger and filling repeatedly, continuous drainage of liver abscess with Pig tail catheter along with antibiotics was required. In very few patients where aspiration could not be possible due to thick pus, septed cavity of abscess, and loculated abscess or there was rupture of abscess in any

Successful percutaneous drainage of large and multiloculated pyogenic liver abscesses in critically ill patients

Introduction: Pyogenic liver abscess continues to be a fatal illness in gastrointestinal, surgical, and critical care fields. the main clinical strategy in large liver abscesses is continued to be dilemmatic between computed tomography (ct)-guided drainage, wide broad spectrum of antibacterial therapy, and urgent abdominal surgery. case series: Herein, we presented two cases of multiloculated, large liver abscesses in critically ill patients treated successfully by ct-guided

Endoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of a self-expandable metallic stent

Endoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of a self-expandable metallic stent

Endoscopic ultrasound-guided hepatic and perihepatic abscess drainage: an evolving technique

Interventional radiology-guided percutaneous drainage of liver abscesses with concomitant use of antibiotics has been the conventional approach for the treatment of liver abscesses. Hepatic abscesses refractory or not amenable to percutaneous drainage have been treated with surgical drainage, either via laparoscopic or open laparotomy techniques. The aim of this review was to evaluate the technical feasibility and efficacy of endoscopic ultrasound (EUS)-guided drainage of liver abscesses. A literature review was performed to identify the studies describing the technique. In this review article we have summarized case series or reports describing EUS-guided liver abscess drainage. The indications, techniques, endoprostheses, limitations and complications reported are discussed. A total of seven cases have been described so far in the literature which included patients with failed conventional treatment modalities. The EUS-guided drainage technique involves puncturing the abscess using endosonography to gain access, passing a guidewire followed by tract dilation and placement of an endoprosthesis for drainage. Studies have reported 100% technical and clinical success rates in selected cases. No complications were reported. EUS-guided drainage of liver abscesses can be a safe and effective alternative approach in the management of liver abscesses in selected patients.

EUS-guided drainage of liver abscess by using a lumen-apposing metal stent (with video)

A 92-year-old man with cholangitis underwent ERCP complicated by incomplete removal of all visualized bile duct stones. Two plastic biliary stents were inserted, and another attempt at stone extraction was planned at a later date. Two months later, the patient was admitted with recurrent cholangitis. CT demonstrated a 10-cm abscess in the left lobe of the liver (A). Intravenous antibiotics were initiated, and the patient underwent repeat ERCP. During the procedure, an obvious bulge was observed in the stomach (B).

When Nature Meets Nurture: Persistent Yersinia Infection

PRESENTATION When the patient’s symptoms are alleviated, it might seem that the causative infection has cleared. But that was not the case for a 62-year-old man with type 2 diabetes who presented with a 1-week history of constipation, lower abdominal cramping, rectal pressure, and hematochezia. In the emergency department, laboratory testing detected leukocytosis with a white blood cell count of 19 x 10 cells/mm and an elevated neutrophil count. Computed tomography (CT) of the patient’s abdomen and pelvis demonstrated marked inflammation of the rectal wall. He was admitted and underwent colonoscopy, which confirmed the presence of proctitis but was otherwise normal. Four days after admission, his stool culture grew pan-sensitive Yersinia enterocolitica. A diagnosis of Yersinia proctitis was made. Simple hepatic cysts seen on CT were felt to be incidental. The patient was prescribed a 5-day course of oral ciprofloxacin. He returned home and had complete symptom resolution. However, 3 weeks after completing treatment, he experienced gradual onset of severe pain that began in the right upper quadrant of the abdomen and radiated to his back and right shoulder. This was accompanied by malaise, intermittent fevers, and anorexia. He reported a 21-pound unintentional weight loss over the preceding 2 months. One month after discharge, he returned to the emergency department.

Laparoscopic drainage of cryptogenic liver abscess

To retrospectively compare the outcomes of percutaneously drained and laparoscopically drained liver abscesses. Eight-five consecutive patients with radiological evidence of liver abscess were treated at National University Hospital of Singapore from 2005 to 2011. Multivariable logistic regression was used to identify failures of intervention. This was defined as persistent objective signs of sepsis. Complications, length of antibiotic therapy, and hospital stay were recorded but not used as indicators for failure of intervention. A propensity score analysis was used to adjust for possible confounders. Twenty-seven (40.3%) patients in the percutaneous group did not respond to primary intervention compared to 2 patients (11.1%) in the laparoscopic group (p = 0.020). Two patients within the percutaneous group died from progression of sepsis despite intervention. In the multivariate model with propensity score, laparoscopic drainage had a protective effect against failure compared to percutaneous drainage of liver abscess (odds ratio [OR], 0.03; 95% confidence interval [CI], [0-0.4]; p = 0.008). There were no differences in complications related to the intervention (p = 0.108). Mean duration of antibiotics (p = 0.437) and hospital stay (p = 0.175) between the groups was similar. Laparoscopic drainage of cryptogenic liver abscesses should be considered as an option for drainage of liver abscess.

Laparoscopic drainage of the liver abscess: case report and literature review

To evaluate the safety and efficacy of the minimally invasive surgical approach (laparoscopic drainage) of liver abscesses in selected cases. Male, 58 years old, from a rural area, presented with epigastric abdominal pain, fever, weight loss, loss of appetite, a palpable mass in the epigastrium and neutrophilic leukocytosis. CT revealed a complex multiloculated liver abscess in segments 2-3. Systemic antibiotic therapy alone was ineffective; percutaneous drainage was excluded due to the characteristics of the lesion. Given the complexity of the lesion, a laparoscopic approach was chosen involving complete drainage of the abscess, debridement and irrigation; the cavity was unroofed using electrocautery and samples were obtained for bacterial culture and drug testing. Two drains were left in the cavity for seven days. No complications were observed. In accordance with the scientific literature, after thorough imaging we performed laparoscopic drainage of a large, complex liver abscess as a safe, effective alternative to open surgery when antibiotic therapy alone failed and percutaneous drainage was uncertain. Not all liver abscesses can be treated with antibiotic therapy or percutaneous drainage. Laparoscopic drainage in association with systemic antibiotic therapy is a safe and effective minimally invasive approach that should be considered in selected patients.

Ultrasound-guided percutaneous drainage of liver abscess: 6 years experience in Lagos State university teaching hospital, Lagos

Introduction: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. The management has improved significantly over the years with the advent of potent antimicrobial agents and advances in diagnostic imaging. Materials and Methods: From August 2007 to May 2013, 32 patients with liver abscess were referred to the Department of Radiology, Lagos University Teaching Hospital, Lagos, Nigeria for ultrasound-guided percutaneous aspiration or drainage. All patients had been treated with antibiotics or antimicrobials for at least 2 weeks before referral and were still being continued for another 6 weeks. Results: A total of 32 patients with liver abscess were successfully treated, consisting 31 males and 1 female. The age ranged from 2 to 72 years with a mean of 43.6 years. A total of -22 (68.75%) patients had percutaneous catheter drainage, while 12 (31.25%) had percutaneous needle aspiration. A total of 15 (46.87%) patients had single abscess, while 5 (15.63%) had two and 12 (37.50%) had more than 2. Most of the abscesses are located on the right in 25 (78.12%). One needle insertion was used per patient. The amount of aspirated pus ranged from 100 to 3000 mL with a mean of 850 mL. Only 10 (31.25%) patients were on admission at the time of drainage, while the others 22 (68.75%) were day cases. Conclusion: We found that needle aspiration and catheter drainage when combined with chemotherapy represents a successful therapeutic approach in the treatment of liver abscess whether pyogenic or amoebic.

Post-partum pyogenic abscess containing Ascaris lumbricoides

We report an unusual case of multiple pyogenic liver abscesses containing Ascariasis lumbricoides in a 35-year-old post-partum female who had delivered 1 month back. Open drainage of liver abscess along with liver worm was done. Patient did well post-operatively.

An Increasing Prominent Disease ofKlebsiella pneumoniaeLiver Abscess: Etiology, Diagnosis, and Treatment

Background. During the past two decades, Klebsiella pneumoniae (K. pneumoniae) had surpassed Escherichia coli (E. coli) as the predominant isolate from patients with pyogenic liver abscess (PLA) in Asian countries, the United States, and Europe, and it tended to spread globally. Since the clinical symptom is atypical, the accurate and effective diagnosis and treatment of K. pneumoniae liver abscesses (KLAs) are very necessary. Methods. Here, we have comprehensively clarified the epidemiology and pathogenesis of KLA, put emphases on the clinical presentations especially the characteristic radiographic findings of KLA, and thoroughly elucidated the most effective antibiotic strategy of KLA. Results. K1 serotype is strongly associated with KLA especially in diabetic patients. Computed tomography (CT) and ultrasound (US) were two main diagnostic methods of KLA in the past. Most of KLAs have solitary, septal lobular abscesses in the right lobe of liver, and they are mainly monomicrobial. Broad-spectrum antibiotics combined with the US-guided percutaneous drainage of liver abscesses can increase their survival rates, but surgical intervention still has its irreplaceable position. Conclusion. The imaging features contribute to the early diagnosis, and the percutaneous intervention combined with an aminoglycoside plus either an extended-spectrum betalactam or a second- or third-generation cephalosporin is a timely and effective treatment of KLA.

Efficacy of three different surgical methods in treatment for bacteria liver abscess

Objective To discuss the clinical effect of the ultrasound or CT-guided percutaneous pus or catheter drainage (CT-PDLA),laparoscopic liver abscess drainage (LD-LA) and abdominal liver abscess incision and drainage (IDLA).Methods 103 cases of pyogenic liver abscess were randomly divided into three groups,which were CT-PDLA group (Group A,35 cases),LD-LA group (Group B,n =34 cases) and IDLA group (Group C,34 cases),and the clinical effects of three groups were compared.Results All patients were cured,the total efficiency of Group A was 100％,Group B for 97.06％,Group C for 82.35％,there was statistical significant difference between them (P＜0.05),but there was no significant difference between Group A and Group B(P＞0.05),there were no significant difference in the biochemical markers of three groups(P＞0.05),for the after conventional indicators,Group A was better than that Group B and Group C (P＜0.05).Conclusion Under the same conditions,exact indications,the CT-PDLA treatment BLA is reliable,simple,economical,having advantages of small trauma,low complications and high cure rate,which can be the preferred treatment choice for bacterial liver abscess. Key words: Bacterial liver abscess; Ultrasound-guided; Laparoscopic drainage; Open drainage

Sporadic incidence of Fascioliasis detected during Hepatobiliary procedures: A study of 18 patients from Sulaimaniyah governorate

BackgroundFascioliasis is an often-neglected zoonotic disease and currently is an emerging infection in Iraq. Fascioliasis has two distinct phases, an acute phase, exhibiting the hepatic migratory stage of the fluke’s life cycle, and a chronic biliary phase manifested with the presence of the parasite in the bile ducts through hepatic tissue. The incidence of Fascioliasis in Sulaimaniyah governorate was unexpected observation. We believe that shedding light on this disease in our locality will increase our physician awareness and experience in early detection, treatment in order to avoid unnecessary surgeries.FindingsWe retrospectively evaluated this disease in terms of the demographic features, clinical presentations, and managements by reviewing the medical records of 18 patients, who were admitted to the Sulaimani Teaching Hospital and Kurdistan Centre for Gastroenterology and Hepatology. Patients were complained from hepatobiliary and/or upper gastrointestinal symptoms and diagnosed accidentally with Fascioliasis during hepatobiliary surgeries and ERCP by direct visualization of the flukes and stone analysis. Elevated liver enzymes, white blood cells count and eosinophilia were notable laboratory indices. The dilated CBD, gallstones, liver cysts and abscess were found common in radiological images. Fascioliasis diagnosed during conventional surgical CBD exploration and choledochodoudenostomy, open cholecystectomy, surgical drainage of liver abscess, ERCP and during gallstone analysis.ConclusionFascioliasis is indeed an emerging disease in our locality, but it is often underestimated and ignored. We recommend the differential diagnosis of patients suffering from Rt. Hypochondrial pain, fever and eosinophilia. The watercress ingestion was a common factor in patient’s history.

Klebsiella pneumoniae liver abscess: a new invasive syndrome

Klebsiella pneumoniae is a well known human nosocomial pathogen. Most community-acquired K pneumoniae infections cause pneumonia or urinary tract infections. During the past two decades, however, a distinct invasive syndrome that causes liver abscesses has been increasingly reported in Asia, and this syndrome is emerging as a global disease. In this Review, we summarise the clinical presentation and management as well the microbiological aspects of this invasive disease. Diabetes mellitus and two specific capsular types in the bacterium predispose a patient to the development of liver abscesses and the following metastatic complications: bacteraemia, meningitis, endophthalmitis, and necrotising fasciitis. For patients with this invasive syndrome, appropriate antimicrobial treatment combined with percutaneous drainage of liver abscesses increases their chances of survival. Rapid detection of the hypervirulent strain that causes this syndrome allows earlier diagnosis and treatment, thus minimising the occurrence of sequelae and improving clinical outcomes.

Pyogenic liver abscess mimicking pleural effusion

Pyogenic liver abscess is a major visceral abscess that may pose a diagnostic dilemma in a febrile child with prominent extra-abdominal symptoms. We present a case of a well-nourished, immunocompetent four-year-old girl who had none of the common predispositions to a liver abscess. Hence, in this unusual setting, pyogenic liver abscess was not considered at the initial assessment, until closer evaluation and futile efforts to drain a seemingly large “pleural effusion” eventually revealed the diagnosis, which was confirmed by imaging. She underwent ultrasound-guided percutaneous drainage of the pyogenic liver abscess to avert the sequelae of this potentially fatal disorder. This underscores the need to think laterally when considering differential diagnoses for the sick child.

Liver abscess caused by Brevundimonas vesicularis in an immunocompetent patient

Invasive infections caused by Brevundimonas vesicularis are very rare in humans. We experienced an unusual case of liver abscess due to B. vesicularis in an immunocompetent young male. The patient was successfully treated by liver abscess drainage and with antimicrobial therapy of ceftriaxone followed by ampicillin/sulbactam. The organism found in the aspiration culture of the abscess material was initially reported, by using a VITEK 2 system, as Sphingomonas paucimobilis. However, later, B. vesicularis was confirmed as the true pathogen through 16S rRNA gene sequencing. To our knowledge, this is the first case of liver abscess caused by B. vesicularis.

Bile Duct Leaks from the Intrahepatic Biliary Tree: A Review of Its Etiology, Incidence, and Management

Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.