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Percutaneous catheter drainage of amoebic liver abscess
V A Saraswat1, D K Agarwal, S S Baijal
1Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Abstract:
Fifteen patients with amoebic liver abscesses underwent percutaneous catheter drainage under ultrasonographic guidance. Thirteen patients had solitary abscesses (right lobe 12, left lobe 1), two had associated subdiaphragmatic collections, while two patients had multiple abscesses. The indications for the drainage included lack of response to medical therapy: imminent rupture in five cases; ruptured liver abscesses in three; enlarging abscesses after hospitalization in three; persistent symptoms in two; and large left lobe abscesses in two. The volume of the abscesses before drainage was 102-1008 ml (mean 432 ml). Pigtail catheters (8 F) were used in nine of the patients and 12 F sump catheters in six. When multiple abscesses and associated subdiaphragmatic collection were present, each was drained separately. The catheters were removed (mean 7 days, range 3-20 days) when patients became apyrexial, catheter drainage was less than 10 ml in 24 h and cavitogram showed a negligible cavity (mean residual volume 5.5 ml, range 3-15 ml). Complications included minor blood loss through the catheter for 12 h in one patient and reappearance of the abscess in another requiring further drainage. Our experience suggests that catheter drainage of amoebic liver abscesses in selected cases is safe and effective, and results in prompt and early resolution of the abscess cavity with restoration of normal parenchyma.
Insights
Percutaneous catheter drainage is a safe and effective treatment for amoebic liver abscesses. This minimally invasive procedure leads to rapid resolution of abscess cavities and restoration of normal liver tissue.
Area of Science:
- Hepatology
- Infectious Diseases
- Interventional Radiology
Background:
- Amoebic liver abscess (ALA) is a common parasitic infection, particularly in endemic areas.
- While medical therapy is the mainstay, complications necessitate alternative treatments.
- Percutaneous drainage is an option for complicated or refractory cases.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous catheter drainage for amoebic liver abscesses.
- To assess the outcomes and complications associated with this interventional procedure.
Main Methods:
- Fifteen patients with ALA underwent percutaneous catheter drainage guided by ultrasonography.
- Pigtail and sump catheters were utilized based on abscess characteristics.
- Drainage criteria included patient's clinical status, output volume, and cavity size on cavitogram.
Main Results:
- The mean abscess volume was 432 ml, with indications including medical non-response, imminent or ruptured abscesses, and enlarging cavities.
- Catheters were removed after a mean of 7 days, with minimal residual cavity volume.
- Minor complications were observed in two patients, with one requiring re-drainage.
Conclusions:
- Percutaneous catheter drainage is a safe and effective therapeutic option for selected patients with amoebic liver abscesses.
- The procedure facilitates prompt resolution of abscess cavities and promotes parenchymal restoration.
- Ultrasonographic guidance ensures accurate catheter placement and effective management.