A dilemma over percutaneous catheter drainage or percutaneous needle aspiration as first-line management of liver abscess

  • Dr. Atul Kumar Assistant Professor, Government Medical College, Ratlam (M.P.) India
  • Dr Shivani Sinha Demonstrator, Department of Microbiology, Government Medical College, Ratlam, India
  • Dr. Praveen Singh Baghel Associate Professor, Department of Surgery, Government Medical College, Ratlam (M.P.), India
DOI: https://doi.org/10.17511/ijoso.2019.i03.12
Keywords: Liver abscess, Catheter drainage, Needle aspiration

Abstract

Background: The aim of the study was to evaluate the clinical presentation and to investigate the effectiveness of percutaneous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses of size more than 5 cm in diameter.

Material and Methods: This was a prospective randomized comparative study of 60 patients, presented in outpatient and admitted at the hospital, randomized equally into two groups, percutaneous needle aspiration and percutaneous catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement and total/near total resolution of abscess cavity. Independent t- test was used to analyze these parameters.

Results: Percutaneous catheter drainage was successful in all the 30 cases. On the other hand, USG guided percutaneous needle aspiration was successful only in 24 of 30 patients (P=0.005). Out of these 24 patients successfully treated, 6 patients required only one aspiration, 12 required two aspirations, and 6 required three aspirations. The 6 patients who did not show clinical improvement and / or decrease in cavity size despite 3 aspirations were taken as failures. In the PNA group, on comparing the cavity volumes the mean cavity volume in those who were successfully treated was 200 ml which was significantly less than those failing treatment; the mean volume being 400 ml. The patients in PCD group showed earlier clinical improvement (P=0.043) and decrease in abscess cavity volume (P=0.001) as compared to those who underwent PNA. In the present study, the success rate was significantly better in percutaneous catheter drainage group (P=0.005) than needle aspiration. The patients in percuaneous catheter drainage group showed earlier clinical improvement (P=0.043) as compared to those who underwent percutaneous needle aspiration.

Conclusion: In the present study, percutaneous catheter drainage is found to be more effective than percutaneous needle aspiration for large liver abscesses of size 5 cm or more in diameter. The clinical improvement is also faster in PCD group than PNA group of the present study.

Downloads

Download data is not yet available.

References

1. Barakate MS, Stephen MS, Waugh RC, Gallagher PJ, Solomon MJ, Storey DW, et al. Pyogenic liver abscess: a review of 10 years' experience in management. Aust N Z J Surg. 1999;69(3):205-209. doi:10.1046/j.1440-1622.1999.01523.x

2. Huang CJ, Pitt HA, Lipsett PA, Osterman FA Jr, Lillemoe KD, Cameron JL, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg. 1996;223(5):600-607.doi:10.1097/00000658-199- 605000-00016

3. Mohan S, Talwar N, Chaudhary A, Andley M, Ravi B, Kumar A. Liver abscess: a clinicopathological analysis of 82 cases. Int Surg. 2006;91(4):228-233.

4. Rajak CL, Gupta S, Jain S, Chawla Y, Gulati M, Suri S. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. 1998;170 (4):1035-1039. doi:10.2214/ajr. 170.4.9530055

5. Zibari GB, Maguire S, Aultman DF, McMillan RW, McDonald JC. Pyogenic liver abscess. Surg Infect (Larchmt). 2000; 1(1):15-21.doi:10.1089 / 1096296003 21254

6. Lo RH, Yu SC, Kan PS. Percutaneous needle aspiration in the treatment of hepatic abscess: factors influencing patients' outcome. Ann Acad Med Singapore. 1998;27(2):173-177.

7. Giorgio A, Tarantino L, Mariniello N, Francica G, Scala E, Amoroso P et al. Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance. Radiol. 1995;195(1):122-124. doi: https://doi.org/ 10.1148/ radiology. 195.1.7892451

8. Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatol. 2004;39 (4):932-938. doi:10.1002/hep.20133

9. Thomas J, Turner SR, Nelson RC, Paulson EK. Postprocedure sepsis in imaging-guided percutaneous hepatic abscess drainage: how often does it occur? AJR Am J Roentgenol. 2006;186(5):1419-1422. doi:10.2214 /AJR.04.1914

10. Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol. 2007;189(3):W138-142. doi:10.2214/AJR.07.2173

11. Singh S, Chaudhary P, Saxena N, Khandelwal S, Poddar DD, Biswal UC. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Annals Gastroenterol: Quarterly Publication of the Hellenic Soc Gastroenterol. 2013;26(4):332-339.

12. Baek SY, Lee MG, Cho KS, Lee SC, Sung KB, Auh YH. Therapeutic percutaneous aspiration of hepatic abscesses: effectiveness in 25 patients. AJR Am J Roentgenol. 1993;160(4):799-802. doi:10.2214/ajr. 160. 4.8456667

13. Giorgio A, Tarantino L, Mariniello N, Francica G, Scala E, Amoroso P, et al. Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance. Radiol. 1995;195(1):122-124.

14. Dietrick RB. Experience with liver abscess. Am J Surg. 1984;147(2):288-291. doi:10.1016/0002-9610(84) 90109-0

15. 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(4):384-388.

16. Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26(6):1434-1438. doi:10.1086/516369

17. Seeto RK, Rockey DC. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine (Baltimore). 1996;75(2):99-113. doi:10.1097 / 00005792-199603000-00006.

18. Alvarez Pérez JA, González JJ, Baldonedo RF, Sanz L, Carreño G, Junco A, et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg. 2001;181(2):177-186. doi:10.1016/s0002-9610(00)00564-x

19. Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess. Modern treatment. Arch Surg. 1991;126(8):991-996. doi:10.1001/archsurg.1991. 01410320077010

20. Saraswat VA, Agarwal DK, Baijal SS, Roy S, Choudhuri G, Dhiman RK, et al. Percutaneous catheter drainage of amoebic liver abscess. Clin Radiol. 1992;45(3):187-189. doi:10.1016 / s0009-9260 (05) 80639-7

21. Gupta SS, Singh O, Sabharwal G, Hastir A. Catheter drainage versus needle aspiration in management of large (>10 cm diameter) amoebic liver abscesses. ANZ J Surg. 2011;81(7-8):547-551.

22. Bertel CK, van Heerden JA, Sheedy PF 2nd. Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage. Arch Surg. 1986;121(5):554-558. doi:10.1001/ archsurg. 1986.01400050072009

23. vanSonnenberg E, Ferrucci JT Jr, Mueller PR, Wittenberg J, Simeone JF. Percutaneous drainage of abscesses and fluid collections: technique, results, and applications. Radiol. 1982;142(1):1-10.doi: 10. 1148/ radiology.142.1.7053517
CITATION
DOI: 10.17511/ijoso.2019.i03.12
Published: 2019-08-31
How to Cite
Kumar, A., Sinha, S., & Singh Baghel, P. (2019). A dilemma over percutaneous catheter drainage or percutaneous needle aspiration as first-line management of liver abscess. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(3), 204-212. https://doi.org/10.17511/ijoso.2019.i03.12
Issue
Vol 5 No 3 (2019): Jul-Aug
Section
Original Article

Most read articles by the same author(s)