Sonographically guided percutaneous treatment of liver abscesses in critically Ill patients

Abstract

Percutaneous management with systemic antibiotics is effective and safe and allows resolution of most LA. However, a small proportion of patients with LA still requires surgical drainage.

Video-assisted hepatic abscess debridement

“…A small proportion of patients with a liver abscess may, therefore, require surgical drainage. In the report of Zerem et al ., percutaneous needle aspiration was performed in 116 patients, with 70 later requiring percutaneous catheter drainage owing to abscess recurrence. In 148 patients, percutaneous catheter drainage had been performed initially but was required twice or more in 63 patients.…”

“…In 148 patients, percutaneous catheter drainage had been performed initially but was required twice or more in 63 patients. Percutaneous treatment was the definitive successful treatment in 230 of 264 patients (87%) but 20 patients (8%) required surgery . Up until now, there have been no randomized controlled trials to compare percutaneous to surgical drainage techniques.…”

“…Percutaneous management combined with systemic antibiotics is effective and safe and resolves most liver abscesses. However, a small proportion of patients may require surgical drainage …”

“…However, a small proportion of patients may require surgical drainage. 3 A similar problem exists for necrotizing pancreatitis, in which the video-assisted retroperitoneal debridement (VARD) procedure provides an excellent alternative to necrosectomy by laparotomy or CT-guided percutaneous drainage in the treatment of infected necrotizing pancreatitis (INP). Although pancreatic necrosis and hepatic abscesses are very different pathological processes, the minimally invasive VARD procedure was adopted for the therapy of persistent or therapy refractory liver abscesses in this study.…”

EUS-Guided Drainage of Liver Abscesses: Ultra Uncertain or Sound Practice?

“…PCD can be performed for single and multiple abscesses located in the right or the left lobe, with technical success approaching 100 % and clinical success close to 85 % [7]. In comparison, EUS-AD is a technically demanding procedure that can be attempted only in major referral centers by echoendoscopists with specific training and experience.…”