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[Percutaneous drainage of amebic hepatic abscess by guided ultraound. Preliminary results]
A Mogollón Prado1, G Molina Sánchez, F Martínez Macías
1Servicio de Gastroenterología, Hospital General de Zona No. 1 IMSS, Aguascalientes, Ags., México.
Abstract:
Amebic hepatic abscess (AHA) is the most frequent extraintestinal complication of amebiasis. Over time, its treatment has gone through some changes and at present is based on amebicides and in some cases, percutaneous drainage. The objective of this work is to present our experience with percutaneous drainage by means of guided ultrasound in patients with AHA. In this work, we include 170 patients admitted to the Gastroenterology Unit of the Hospital General de Zona No. 1, (IMSS) in Mexico City during a period of eight years (1990-1997). These cases included the following criteria: Failure to medical therapy, AHA of liquid matter greater than 5 cm determined by ultrasound; risk of rupture, prolonged incapacity with no data of toxico-infection, accessible drainage route; availability of operating room before risk of complication, and normal coagulation tests. A modified Seldinger's technique was utilized. A single punction was carried out in 131 patients, who had only one abscess. Thirty-nine patients required a second evacuation on presenting two abscesses, and in four cases, a third evacuation was required due to the presence of three or more abscesses. Only one case required an urgent surgical procedure due to abscess rupture to pleura. Five patients suffered complications, including the latter. The remaining four patients had a spontaneous resolution. All patients were released during the 24 hours following surgery, and no patient required hospitalization. For this reason, this can be considered a procedure that in the expert hands of interventionist radiologists, has less morbidity. This work will be carried out to 10 years.
Insights
Ultrasound-guided percutaneous drainage is an effective treatment for amebic hepatic abscess (AHA). This minimally invasive procedure offers a low morbidity option for patients failing medical therapy, with most patients discharged within 24 hours.
Area of Science:
- Hepatology
- Infectious Diseases
- Interventional Radiology
Background:
- Amebic hepatic abscess (AHA) is the most common extraintestinal manifestation of amebiasis.
- Current AHA treatment involves amebicides and, in select cases, percutaneous drainage.
- Ultrasound-guided percutaneous drainage has emerged as a key intervention for managing AHAs.
Purpose of the Study:
- To present the experience with ultrasound-guided percutaneous drainage for amebic hepatic abscess (AHA).
- To evaluate the efficacy and safety of this minimally invasive approach in a large patient cohort.
Main Methods:
- Retrospective analysis of 170 patients with AHA treated between 1990 and 1997.
- Inclusion criteria: failure of medical therapy, abscess size >5 cm, risk of rupture, and accessible drainage.
- Modified Seldinger technique utilized for ultrasound-guided percutaneous drainage.
Main Results:
- 131 patients required a single drainage procedure; 39 needed a second, and 4 required a third.
- Only one patient underwent urgent surgery due to pleural rupture; five patients experienced complications overall.
- All patients were discharged within 24 hours post-procedure, with no hospitalizations required.
Conclusions:
- Ultrasound-guided percutaneous drainage is a safe and effective treatment for amebic hepatic abscess (AHA).
- The procedure demonstrates low morbidity when performed by experienced interventionist radiologists.
- This technique facilitates rapid patient recovery and discharge, minimizing the need for hospitalization.