Pyogenic liver abscess surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
The maninstay of treatment of pyogenic liver abscess is percutaneous darinage of abscess. Other methods used are open surgical drainage and endoscopic retrograde cholangiopancreatography(ERCP).[1][2][3][4][5]
Drainage of Pyogenic Liver Abscess
The following methods are used for drainage of pyogenic liver abscess.
| Drainage | |||||||||||||||||||||||||
| Percutaneous drainage | Open surgical drainage | Endoscopic retrograde cholangiopancreatography (ERCP) | |||||||||||||||||||||||
| CT guided | Ultrasound guided | ||||||||||||||||||||||||
Percutaneous Drainage
- The drainage method used depends on the size and number of abscesses.[1][2][3][4]
- A single abscess with size less than 5 cm can be drained using either percutaneous catheter drainage or needle aspiration.
- If the abscess size is more than 5 cm, percutaneous catheter drainage is preferred over needle aspiration.[4][6]
- The catheters are placed until the drainage is minimal or upto 7 days.[7][8]
- For multiple or loculated abscesses which are small and easily accessible, percutaneous drainage can be used to drain the abscess.
Surgical Drainage
Indications for surgical drainage of pyogenic liver abscess include:
- Ruptured abscess
- Hyperbilirubinemia or renal impairement
- Multiple and loculated abscesses which cannot be easily accessible by percutaneous drainage
- Inadequate drainage through percutaneous methods
- Blockage of catheter due to increased viscosity of abscess
- Associated with an underlying disease like peritonitis
ERCP
In patients with bile duct stones or strictures, endoscopic retrograde cholangiopancreatography (ERCP) is used to drain the pyogenic liver abscess.[5]
References
- ↑ 1.0 1.1 Rajak CL, Gupta S, Jain S, Chawla Y, Gulati M, Suri S (1998). "Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage". AJR Am J Roentgenol. 170 (4): 1035–9. doi:10.2214/ajr.170.4.9530055. PMID 9530055.
- ↑ 2.0 2.1 Ch Yu S, Hg Lo R, Kan PS, Metreweli C (1997). "Pyogenic liver abscess: treatment with needle aspiration". Clin Radiol. 52 (12): 912–6. PMID 9413964.
- ↑ 3.0 3.1 Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS; et al. (2004). "Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration". Hepatology. 39 (4): 932–8. doi:10.1002/hep.20133. PMID 15057896.
- ↑ 4.0 4.1 4.2 Zerem E, Hadzic A (2007). "Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess". AJR Am J Roentgenol. 189 (3): W138–42. doi:10.2214/AJR.07.2173. PMID 17715080.
- ↑ 5.0 5.1 Lam YH, Wong SK, Lee DW, Lau JY, Chan AC, Yiu RY; et al. (1999). "ERCP and pyogenic liver abscess". Gastrointest Endosc. 50 (3): 340–4. doi:10.1053/ge.1999.v50.98065. PMID 10462653.
- ↑ Mohsen AH, Green ST, Read RC, McKendrick MW (2002). "Liver abscess in adults: ten years experience in a UK centre". QJM. 95 (12): 797–802. PMID 12454322.
- ↑ Liao WI, Tsai SH, Yu CY, Huang GS, Lin YY, Hsu CW; et al. (2012). "Pyogenic liver abscess treated by percutaneous catheter drainage: MDCT measurement for treatment outcome". Eur J Radiol. 81 (4): 609–15. doi:10.1016/j.ejrad.2011.01.036. PMID 21330079.
- ↑ Tan YM, Chung AY, Chow PK, Cheow PC, Wong WK, Ooi LL; et al. (2005). "An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm". Ann Surg. 241 (3): 485–90. PMC 1356988. PMID 15729072.