Percutaneous Drainage Of Liver Abscess Research Articles

Percutaneous drainage of liver abscess in three public hospitals in Paraguay

Percutaneous drainage of liver abscess in three public hospitals in Paraguay

RESULTS OF THE ANTIBIOTICS TREATMENT COMBINED WITH LIVER ABSCESS DRAINAGE AT NGUYEN TRI PHUONG HOSPITAL

Background: Percutaneous drainage of liver abscess is the initial treatment of choice for abscesses larger than 5 cm in size and has long been applied in many hospitals in Vietnam. However, there are not many summary reports on both antibiotic treatment and abscess drainage under ultrasound guidance. Subjects and methods: Retrospective study of patients with liver abscess who were treated with antibiotics and drained the abscess under ultrasound guidance at Nguyen Tri Phuong Hospital from January 2017 to March. 12/2022. Results: There were 61 patients included in the study. The first-line antibiotic treatment is Cephalosporin III generation combined with intravenous metronidazole, most are sensitive to third generation Cephalosporins (49.2%), 8.2% are multi-resistant ESBL-secreting bacteria using Carbapenems. The treatment success rate is high (96.7%). The time for the patient to have no fever and no pain in the right lower quadrant is from 1 to 4 days. Most of the interventions were 1 time (90.2%). The average tube retention time was 12 days. Conclusion: Treatment of liver abscess with antibiotics combined with ultrasound-guided drainage is an effective and safe measure. Most of the cases are only intervention 1 time with high success rate.

Assessment of the Outcome of USG Guided Percutaneous Drainage of Liver Abscess with and Without Administration of Intra Cavitary Meropenem & Urokinase

Assessment of the Outcome of USG Guided Percutaneous Drainage of Liver Abscess with and Without Administration of Intra Cavitary Meropenem & Urokinase

Percutaneous drainage of liver abscess under ultrasound guidance combined with etiological antibacterial therapy: a successful case of patient treatment

The article describes a clinical case of successful treatment of multiple liver abscesses in a 43‑year-old man with severe comorbidity and history of aggravating factors. The patient underwent combined treatment: surgery, consisting in the abscess puncture, and antibacterial therapy, first empirical, then etiological, taking into account the data of bacteria culture test. The importance of rational combinations of surgical care and antibacterial therapy is also discussed.

Direct Puncture Pigtail Catheter Placement for Secure Management of the Liver Abscess

Background: Liver abscess is a common cause of morbidity and mortality in developing countries. The availability of advanced imaging in developing countries has led to diagnosis and treatment of patients at an early stage and management with local anesthesia. ObjectiveThe objective was to establish direct puncture pigtail catheter placement as a secure management method for liver abscess drainage. MethodsOur prospective study was performed on 170 patients at our tertiary hospital for 2 years between April 2019 and March 2021. Patients diagnosed with liver abscess on ultrasonography (USG) were included in our study. Percutaneous drainage of the abscess is done, and serial USG scans were performed to determine the effectiveness of the procedure. ResultsOut of the 170 patients with a liver abscess who have undergone USG-guided pigtail catheterization for solitary liver abscess (size greater than 5 cm), the occurrence was predominantly in the right lobe (69.5%), with volume more than 150 cc. The study showed no significant complications with a success rate of 98%. ConclusionsUSG-guided percutaneous drainage of liver abscess is minimally invasive with a satisfactory outcome to mark it as the first line of management in liver abscess.

The Use of Mucolytic Agent in Percutaneous Drainage of Liver Abscess: A Case-Series Analysis.

Background: Liver abscess is a scarce but potentially fatal suppurative process. There is a general tendency for minimally invasive treatment, such as broad-spectrum antibiotherapy and percutaneous drainage. Multiloculated, multiple or incompletely liquefied abscesses often limit the efficacy of percutaneous drainage. This study aims to assess the effectiveness of percutaneous drainage and intracavitary instillation of a mucolytic agent for liver abscesses. Material and method: From our department database, we have identified patients with liver abscess admitted during the period 2015 - 2020, treated by ultrasound-guided percutaneous drainage and intracavitary instillation of mucolytic agent. Data regarding imaging appearance, drainage technique, inflammatory markers and clinical course were assessed. Results: Twenty-one patients with multiloculated liver abscesses, sized 8 to 17 cm, were percutaneously drained, with local anaesthesia, under ultrasound guidance. The bacteriological exam of the aspirate showed bacterial infection in 19 cases, mostly Klebsiella pneumoniae, and 2 fungal infections. Acetylcysteine in dilution 1: 1 with saline was instilled daily on the 12F or 14 F drainage catheter. Clinical and radiological resolution was achieved within 14 to 29 days. Two cases required supplementary drainage of a non-communicating residual cavity. There were no complications, periprocedural deaths or relapse at 3 months follow-up. Conclusions: Percutaneous drainage is effective even in the management of multiloculated liver abscesses, facilitated by the use of intracavitary mucolytic agent.

Editorial.

Liver surgery continues to evolve, as knowledge of liver anatomy and physiology deepens, new technologies are introduced, and the experience of surgical teams increases. Internationally, liver surgery is part of a very well-defined subspecialty today, namely "hepato-biliary-pancreatic surgery". The United States has a two-year post-residency training system (Fellowship). Europe has an examination organized by UEMS in which candidates must demonstrate specific training in one or more HPB units. A two-year training certificate in hepato-biliary-pancreatic surgery was introduced in Romania, coordinated by three centers: Fundeni Clinical Institute in Bucharest, Sfantul Spiridon Hospital in Iasi and Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca. The first two centers also provide training for liver transplantation. This special issue primarily reflects the experience of these three centers, to which are added newer ones, under development. One of these new centers (the Surgical Department II "Sf. Maria" Hospital in Bucharest), represented by C. Stroescu et al, presents a valuable experience in HPB surgery accumulated in the last 7 years. The importance of anatomy in liver surgery is underlined by the work of L. Simion et al, which analyzes the anatomical variants of the hepatic artery and their importance in resection and transplant surgery. Current liver surgery necessarily involves intraoperative ultrasound, which is highlighted in the excellent review by A. Bartos et al in the particular case of resections for hepatocellular carcinoma. Also, the importance of this exploration results from the experience of liver resections for metastases of stromal gastrointestinal tumors (GIST) analyzed by A. Kraft et al. An important advance in liver surgery was the minimally invasive, laparoscopic or robotic approach. M. Marino et al. present an interesting experience in robotic liver surgery. Among the other topics addressed, we retain the method called ALPPS (Associating liver partition and portal vein ligation for staged hepatectomy). Viewed with reservations at first and even met with severe criticism, ALPPS seems to have prevailed now, the results being considered convincing by most authors. This is reflected in two articles: A review article by F. Botea et al based also on an important experience both in Fundeni Hospital, but mainly in the Department of Surgery in Zurich and Kiel. The personal experience of A. Hotineanu et al. We were honored to include this article from the Republic of Moldova, especially since there is still a close connection between the surgery center at the Republican Hospital in Chisinau and the Romanian surgery. The progress made in liver transplantation is reflected in the work of Nicolaescu et al on the experience of Fundeni center in hypothermic mechanical oxygenated perfusion of liver grafts, one of the most important developments in transplantation in recent years, which contributed significantly to the continuous improvement of postoperative results. Hydatid cyst surgery could not be missed, in a country where this pathology is still widespread enough. The work of C. Molnar et al addresses a complicated form of the disease, namely multiple hydatid cyst. This special issue covers also the topic of interventional treatment, in the article of Lupascu et al about the percutaneous drainage of liver abscess. Two of the works are dedicated to bile duct surgery: A. Bartos at al. presents the personal experience on portojejunostomy in cases of complex lesions of the extrahepatic bile duct; R. Popescu et al. presents the personal experience on the management of residual gallbladder and cystic duct stump stone after cholecystectomy. The video presentations bring a special added value in a difficult and spectacular surgery, not without risks. It is worth noting first of all the video with the resection of a giant hepatic artery aneurysm (V. Brasoveanu et al), as well as the two films of complex ultrasound- guided resections of F. Botea et al. I am convinced that the video of M. Marino et al on robotic left hemihepatectomy will surely be very much appreciated by the readers of Chirurgia.

A case study of chemical peritonitis due to biliary leakage in post pigtail catheterization

Generalized biliary peritonitis is a serious intra-abdominal emergency. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.Liver abscess with biliary communication poses management problem if percutaneous drainage is performed. We describe a rare case of biliary peritonitis in amoebic liver abscess due to rupture of an intra hepatic biliary radical after insertion of pigtail catheterisation. Prolonged high‑output bile after percutaneous drainage of liver abscess resulted biliary peritonitis and after surgical drainage also suspicion of communication of abscess with intrahepatic bile ducts (biliary fistula). Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

A clinical study on the presentation and management of liver abscess in eastern Uttar Pradesh and evaluation of a low cost technique of percutaneous catheter drainage

Background: The objective of the study was to assess the outcome of various modalities of treatment and evaluation of a low cost technique of percutaneous catheter drainage of liver abscess.Methods: A prospective study of patients with liver abscess was conducted in a tertiary care centre over a period of one year. Since the cost of commercially available catheter (pig tail type) for image guided percutaneous drainage of liver abscess is quite high (approx Rs 800) and considering the fact that a considerable population in eastern Uttar Pradesh is poverty stricken, this study includes an evaluation of low cost technique of percutaneous drainage of liver abscess as a pilot project. In the present study K-90 was used as “low cost drainage” and compared with pig tail catheter drainage.Results: Total 34 patients with liver abscess were enrolled in the study. 31 cases were male and 3 cases were female. 34 cases were subjected to catheter drainage (pig tail catheter, K-90) yielding varying quantities of pus from 300 ml to 2200 ml, depending on the size of the abscess. 15 out of 34 patients underwent tube drainage (K-90) by our innovative trochar cannula system using 5 mm laparoscopic metal trochar.Conclusions: Although, compared to pig tail drainage, K-90 tube drainage is associated with more number of minor complication and prolonged hospital stay, however looking to the advantages and greatly reduced cost its use is probably justified.

Role of surgery in management of liver abscess

Introduction: Liver abscess is a common disease in developing world. Its treatment has evolved in last few years to become less and less invasive. Percutaneous drainage of liver abscess is a wellestablished method and probably most widely accepted as well. However, large and multiloculated abscess containing thick pus may not be suitable for such methods.Methods: All patients with liver abscess, who could not be drained or not found suitable for percutaneous drain insertion and eventually underwent surgery were included in the study.Results: Total 8 patients were treated by surgical drainage, open or laparoscopic technique. Surgical drainage was effective way of treatment for abscesses not treatable by needle aspiration or percutaneous tube drain insertion with good outcome.Conclusion: In patient of liver abscess who has large multiloculated abscess with thick pus or not suitable for percutaneous drainage, surgical treatment either laparoscopic or open can be an effective and successful. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 20-22

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.

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.

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.

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.

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.

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.

Sonographically-guided percutaneous drainage of liver abscesses: Follow-up of long-term results

Sonographically-guided percutaneous drainage of liver abscesses: Follow-up of long-term results

Intrahepatic abscess due to gallbladder perforation.

Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment. The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis. Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions. Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.