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[Amebic abscess of the liver: ultrasound guided puncture]
L Pham Van1, H Duong Manh, H Pham Nhu
1Service de Chirurgie, Faculté de Médecine, HUE (Vietnam).
Abstract:
The aim of this study is to present the results of ultrasound-guided needle aspiration in amoebic abscess of the liver in 1289 patients. Out of 1512 patients hospitalized from 1990 to 1995 for an amoebic abscess of the liver, 1289 (83.6%) were treated by this approach. The abscesses of less than 40 mm (8.9%) were treated medically, and those of more than 170 mm (0.6%) were operated on. The abscesses with peritonitis (5.2%) were also operated on. A treatment with metronidazole or dehydroemetin was associated with the surgical treatment or with the aspiration of the abscess. There was no death. A second aspiration was necessary in 24.9% of the patients, and a third one in 9.4%. Three complications were observed, two hemorrhages and one fistula. Nine patients had a recurrent abscess after their discharge from hospital. Four failures were observed in patients with abscesses of more than 170 mm in diameter. Results were considered as good in 1273 patients (98.7%). These results suggest that in amoebic abscess of the liver with a diameter between 40 and 170 mm, aspiration associated with amoebic treatment may be the standard treatment. Smaller abscesses usually recover with medical treatment alone, and greater abscesses need surgical drainage.
Insights
Ultrasound-guided needle aspiration is effective for treating amoebic liver abscesses between 40-170 mm. This minimally invasive approach, combined with medication, offers a high success rate with few complications.
Area of Science:
- Hepatology
- Infectious Diseases
- Medical Imaging
Background:
- Amoebic liver abscess (ALA) is a significant global health concern.
- Effective management strategies for ALA are crucial to reduce morbidity and mortality.
Purpose of the Study:
- To evaluate the efficacy and safety of ultrasound-guided needle aspiration for treating amoebic liver abscesses.
- To determine optimal treatment strategies based on abscess size and clinical presentation.
Main Methods:
- Retrospective analysis of 1289 patients with ALA treated between 1990 and 1995.
- Ultrasound-guided needle aspiration as the primary intervention for abscesses 40-170 mm.
- Medical management for smaller abscesses (<40 mm) and surgical drainage for larger ones (>170 mm) or those with peritonitis.
Main Results:
- Ultrasound-guided needle aspiration was performed in 83.6% of hospitalized patients.
- A high success rate of 98.7% was achieved with aspiration.
- Repeat aspirations were needed in 24.9% (second) and 9.4% (third); complications were rare (hemorrhage, fistula).
Conclusions:
- Ultrasound-guided needle aspiration, coupled with anti-amoebic therapy, is a safe and effective standard treatment for ALA between 40-170 mm.
- Medical treatment alone suffices for smaller abscesses, while larger or complicated cases require surgical intervention.
- This approach significantly improves patient outcomes and minimizes invasive procedures.