Management of complex hepatic abscess by percutaneous catheter drainage: a case report

Abstract

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.