Safety and Efficacy of Percutaneous Ultrasound-Guided Needle Aspiration of Liver Abscesses in a Resource-Scarce Environment

Abstract

Background: Liver abscess is a condition found in both the developed and the developing countries (including Nigeria), which was normally treated with drugs alone. Refractory patients who were initially treated by open abdominal surgery are now successfully treated with minimally invasive approach from increased availability and access to ultrasound in low-resource settings where the burden of liver abscess is still significant. To our knowledge, not much data are available in our environment on a large series of patients with liver abscess managed solely with percutaneous needle aspiration under ultrasound guidance in combination with systemic and local abscess sac antibiotic treatment. We, therefore, report our experience in the management of liver abscess in Goshen Diagnostic Services, Kaduna, Nigeria (a private diagnostic center). Aim: The aim of this study was to describe our experience in the ultrasound-guided percutaneous management of liver abscesses over a period of 8 years in a private diagnostic center and to review the literature. Materials and Methods: This prospective study was conducted over an 8-year period at Goshen Diagnostic Services (a privately owned diagnostic outfit with only outpatient facility), Kaduna, Nigeria, from June 2012 to May 2020, involving 77 adult patients (62 male and 15 female) with liver abscess who were referred from various medical facilities within the city just for drainage purposes. Results: A total of 77 patients were eligible for the study consisting of 62 males and 15 females (male-to-female ratio of 4:1). Fifty-eight (75.3%) of them were referred from government/public hospitals, whereas 19 (24.7%) were from privately owned medical centers. Fifty-three (68.8%) patients were referred when still on admission in the various hospitals, whereas 24 (31.2%) came as outpatients. Twenty-eight percent of them required only a single aspiration, whereas 38.9% and 24.7% had to go for a second and third episode, respectively. The success rate was 100% after 6 months of follow-up. Conclusion: Liver abscess management used to be a surgical dilemma with substantial morbidity and mortality but has currently become minimally invasive. At present, morbidity and mortality have markedly diminished, with reduced cost to the patient. The direct infiltration of drugs into the abscess sac has improved the success rate.