Pyogenic liver abscess: treatment with needle aspiration

Percutaneous needle aspiration as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of pyogenic liver abscess has never been popular. The authors report their experience with needle aspiration and evaluate its safety, effectiveness and role in treating pyogenic liver abscess.

The results of needle aspiration performed in 101 liver abscesses of 64 unselected consecutive patients with male to female ratio of 2.5:1 and average age 56.3 +/- 16 years were reviewed. The abscesses were pyogenic in 63 patients (98.4%), and multiple in 18 patients (28.1%). Thirty-nine abscesses (38.6%) were > or = 5 cm in diameter. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles and ultrasound guidance.

The percentage of abscesses requiring one, two and three, or more sessions of aspiration was 49.5%, 23.7% and 26.7%, respectively. The overall success rate was 96.8%. The success rate was unrelated to the largest size or number of abscess in the patient. Two patients died from uncontrolled sepsis. One serious complication of liver laceration requiring laparotomy occurred.

Percutaneous needle aspiration in combination with systemic antibiotics is safe and effective in treating pyogenic liver abscess, it should be considered as a first line alternative to catheter drainage, especially for multiple abscesses. The need for repeat aspirations follows a 'fifty per cent rule'.