Management of complex hepatic abscess by percutaneous catheter drainage: a case report
Keywords:Liver, Abscess, Drainage, Amoebiasis, Catheter
Liver abscesses are a commonly encountered pathology in the tropical setting. Most commonly these are secondary to amoebic infestation. Majority of liver abscesses present with abdominal pain confined to the right hypochondrium. Smaller abscesses are easily dealt with by needle aspiration or catheter drainage under image guidance. Larger and complex abscesses are commonly dealt with by surgical drainage. We deal here with a case of complex liver abscesses which even had perforated into the pleural cavity. Keeping a close watch on the patient’s general condition which was satisfactory, we did not rush into a major surgical procedure. Wide antibiotic coverage and pulmonary care were initiated. Two pig-tail catheters were placed in separate abscesses and metronidazole irrigation periodically done. The daily drain output gradually reduced and we could successfully remove the two catheters at an interval. The patient made a good recovery and continues to do well on follow-up. We see in this case that even large and multiple abscesses if meticulously managed, surgical drainage can be avoided and catheter drainage provides satisfactory results. Good antibiotic coverage must continue in the follow-up period too.
Prakash V, Jackson -Akess JY, Oliver TI. Amebic Liver Abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
Arellano-Aguilar G, Marin-Santillan E, Castilla-Barajas JA, Bribiesca-Juarez MC, Dominguez-Carrillo LG. A brief history of amoebic liver abscess with an illustrative case. Rev Gatroenterol Mex. 2017;82(4):344-8.
Hughes MA, Petri WA Jr. Amebic Liver Abscess. Infect Dis Clin North Am. 2000;14(3):565-82.
Singh A, Banerjee T, Kumar R, Shukla SK. Prevalence of cases of amebic liver abscess in a tertiary care centre in India: A study on risk factors, associated microflora and strain variation of Entamoeba histolyitica. PLoS ONE. 2019;14(4):e0214880.
Jayakar Sudhir R, Nichkaode Prabhat B. Liver abscess- management strategies and outcome. Int Surg J. 2018;5(9):3093-101.
Mohit Bhatia, Murtuza Ali. Ruptured liver abscess: analysis of 50 cases. Med J D Y Patil Univ. 2017;10:532-5.
Hoffner RJ, Kilaghbian T, Esekogwu VI, Henderson SO. Common presentations of amebic liver abscess. Ann Emerg Med. 1999;34(3):351-5.
Singh S, Chaudhary P, Saxena N, Khandelwal S, Poddar DD, Biswal UC. Treatment of liver abscess : prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol. 2013;26(4):332-9.
Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: Do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009;20:1059-65.
Ogawa T, Shimizu S, Morisaki T, Sugitani A, Nakatsuka A, Mizumoto K, et al. The role of percutaneous transhepatic abscess drainage for liver abscess. J Hep Bil Pancr Surg. 1999;6:263-6.
Dulku G, Mohan G, Samuelson S, Ferguson J, Tibballs J. Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review. AMJ. 2015;8(1):7-18.