Outcome of ultrasound guided pigtail catheter drainage of liver abscesses a prospective study of 126 cases

Authors

  • Sayeed Majid Malik Department of Surgery, Government Medical College and Hospital, Jammu, J&K
  • Sanjay Kumar Bhasin Department of Surgery, Government Medical College and Hospital, Jammu, J&K
  • Tariq P. Azad Department of Surgery, Government Medical College and Hospital, Jammu, J&K

DOI:

https://doi.org/10.18203/2349-2902.isj20151093

Keywords:

Pyogenic liver abscess, Amoebic liver abscess, Pig tail catheter, Ultrasound guided

Abstract

Background:With the advances in the intervention radiological techniques the laparotomy for liver abscess has been taken over by the percutaneous ultrasound guided needle aspiration as well as percutaneous ultrasound guided pigtail catheter drainage. This study was undertaken at Govt. Medical College & Associated hospitals, Jammu to assess the outcome of this minimally invasive procedure for Liver abscess.

Methods: 126 patients were subjected to pigtail catheter drainage after localization with ultrasonography using modified Seldinger’s technique. The pigtail catheters of 8-14 Fr size was were used. All the samples of pus were subjected to microscopy for EH trophozoites, Gram stain and for pus culture and sensitivity. Patient’s vitals were monitored for 24 hours. Daily estimation of volume, colour and consistency of the drainage fluid was recorded. Follow-up USG was done on average of 5th postoperative day to assess the shrinkage of cavity and the amount of residual fluid. Removal of catheter was decided based on; the amount of pus drained (<50 ml for three consecutive days); disappearance of symptoms & signs; and USG abdomen showing signs of resolution.

Results:The age of the patients in this study ranged from the 21 years to 70 years with M: F ratio of 13.5: 1. Pain, fever, tender hepatomegaly & anaemia were common symptomatology. Right lobe abscess was seen in 74.60% (n=94) of patients. Solitary abscess was seen in 110 patients (87.3%). 66 patients (52.38%) had ALA, 18 patients PLA & 42 were having indeterminate liver abscess. Smaller size catheter specially 8-10 Fr invariably blocks. Common problems encountered were local pain or discomfort due to catheter, peri-tubal leak in few cases, and local wound infection. The average period of continuous catheter drainage was 7.2 days maximum being 26 days. Average duration of hospital stay was 2.45 days. Success rate of the procedure was 96.82% (n=122). 04 patients needed laparotomy.

Conclusions:Advances in interventional radiology have influenced management of liver abscess. We in our series of 126 pts of liver abscess conclude that image guided percutaneous pigtail drainage of liver abscess is a safe, effective minimally invasive procedure with negligible morbidity and no mortality. High procedural success rate has almost replaced conventional laparotomy in uncomplicated liver abscess.

References

Khan R, Hamid S, Abid S.Predictive factors for early aspiration in liver abscess. World J Gastroenterol. 2008;14:2089-209.

Thomas PG, Garg N. Amebiasis and other parasitic infections. Blumgart LH, Belghiti J, Jarnajin WR.. Surgery of the Liver, Biliary Tract and Pancreas, 4th edition. 2009;2:935-51.

Strong RW. Pyogenic liver abscess. Blumgart LH, Belghiti J, Jarnajin WR. Surgery of the Liver, Biliary Tract and Pancreas, 4th edition. 2009;2:927-33.

Bertek CK, van Heerden JA, Sheedy PF. Treatment of pyogenic hepatic abscesses. Arch Surg. 1986;121:554-8.

Rintoul R, O’Riordain MG, Laurenson IF. Changing management of pyogenic liver abscess. Br J Surg. 1996;83:1215-8.

Turill FL and Brunham JR. Hepatic amoebiasis. Am J Surgery 1996; 11: 424-30.

Ochsner A, DeBackey M, Murray S et al. Pyogenic abscess of liver. An analysis of 47 cases with a review of literature. Am J surg. 1938;40:292-319.

Sharma MP, Verma N, Acharaya SK. Clinical profile of multiple liver abscesses. A study of 56 cases. J Asso Physicians of India. 1990;38:837-9.

Data DV, Saha S, Singh SA. The clinical pattern and prognosis of patients with amoebic liver abscess and jaundice. Am J Digestive Disease. 1973;18:883-98.

Greaney GC, Reynolds TB, Donovan AJ. Ruptured amebic liver abscess. Arch Surg. 1985;120:555-61.

Nordestgaard AG, Stapleford L, Worthen N. Contemporary Management of Amoebic Liver Abscess. Am Surg. 1992;58:315-20.

Angelica MD, Fong Y. The liver. Townstead MC, Beauchamp RD, Evers BM et al Sabiston Text Book of Surgery, 18th edition. 2010;2:1463-523.

Pearce NW, Knight R, Irving H. Non-operative management of pyogenic liver abscess. HPB (Oxford). 2003;5:91-5.

Balaguera JC, Estevan JA, Segovia JC et al. Primary pyogenic liver abscess: current treatment options. Internet J Surg. 2009;18.

Hanna RM, Dahniya MH, Badr SS. Percutaneous cathether drainage in drug-resistant amoebic liver abscess. Trop Med Inter Health. 2000;5(8):578-81.

Hippocrates. The Genuine Works of Hippocrates, vols 1 & 2. Transl [from the Greek with a preliminary discourse and annotations]. New York: William Wood & Co. 1886:57,58,266,267.

Cook GC. Gastroenterological emergencies in the tropics. Baillieres Clin Gastroenterol. 1991;5:861-86.

Reeder MM. Tropical diseases of the liver and bile ducts. Semin Roentgenol. 1975;10:229-43.

Hughes MA, Petri WA Jr. Amebic liver abscess. Infect Dis Clin North Am. 2000;14:565-82.

Chiu CT, Lin DY, Wu CS, Chang-Chien CS, Sheen IS, Liaw YF. A clinical study on pyogenic liver abscess. Taiwan Yi Xue Hui Za Zhi. 1987;86:405-12.

Barnes PF, De Cock KM, Reynolds TN, Ralls PW. A comparison of amebic and pyogenic abscess of the liver. Medicine (Baltimore). 1987;66:472-83.

Hoffner RJ, Kilaghbian T, Esekogwu VI, Henderson SO. Common presentations of amebic liver abscess. Ann Emerg Med. 1999;34:351-5.

Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. 1990;212:655-62.

Sharma MP, Kumar A. Liver abscess in children. Indian J Pediatr. 2006;73:813-7.

Khan R, Hamid S, Abid S. Predictive factors for early aspiration in liver abscess. World J Gastroenterol. 2008;14:2089-93.

Alvarez Pérez JA, González JJ, Baldonedo RF.. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg. 2001;181:177-86.

Chou FF, Sheen-Chen SM, Chen YS, Chen MC. Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment. World J Surg. 1997;21:384-8.

Wong W-M, Wong BCY, Hui CK. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period. J Gastroenterol Hepatol. 2002;17:1001-7.

Wang JH, Liu YC, Lee SS. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26:1434-8.

Singh S, Caudhary P, Saxeena N. Treatment of liver abscess:prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol. 2013;26(4):332-9.

Martin E, Fankuchen E, Neff R. Percutaneous drainage of abscesses: A report of 100 patients. Clin Radiol. 2009;35:9-11.

Ng SS, Lee JF and Lai PB. Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. World J Gastroenterol. 2008;14:747-51.

Nordestgaard AG, Stapleford L, Worthen N. Contemporary management of amebic liver abscess. Am Surg. 1992;58:315-20.

Rubin RH, Swartz MN, Malt R. Hepatic abscesses: Changes in clinical, bacteriological and therapeutic aspects. Am J Medicine. 1974;57:601-10.

Nordestgaard AG, Stapleford L, Worthen N. Contemporary management of amebic liver abscess. Am Surg. 1992;58:315-20.

Martin E, Fankuchen E, Neff R. Percutaneous drainage of abscesses: A report of 100 patients. Clin Radiol. 2009;35:9-11.

Liu CH, Gervais DA, Hahn PF. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009;20:1059-65.

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Published

2016-12-14

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Original Research Articles