scholarly journals A comparative study of liver abscess: therapeutic aspiration verses continuous catheter drainage

2019 ◽  
Vol 6 (3) ◽  
pp. 922
Author(s):  
Unmed Chandak ◽  
Prenoy Araujo ◽  
Arti Mitra

Background: Previously liver abscesses were treated primarily by surgery but with advances in imaging techniques the trend is changing towards use of potent antimicrobials and minimally invasive ultrasound guided interventional procedures and surgery is being done only in selected cases. We conducted this study to find out the feasibility, limitations, effectiveness, outcome and complications of therapeutic needle aspiration and continuous catheter drainage of liver abscess.Methods: This was a hospital based randomized control prospective study in which patients with liver abscess were included. 100 patients of liver abscess selected by simple randomization to 2 groups namely Group A (needle aspiration) or Group B (continuous catheter drainage) undergo the above two interventional procedures. For statistical purposes P value less that 0.05 was taken as statistically significant.Results: This study consisted of 100 patients out of whom there were 78 (78%) males and 22 (22%) females with a M:F ratio of 1:0.28. Single hepatic abscess (75%) was more common than multiple abscesses (25%) and pyogenic abscess (67%) was more common than amoebic abscess (33%). Right lobe of liver was most commonly involved (61%) followed by left lobe (22%). All patients in both the groups were treated successfully and there was no treatment failure in any of the groups.Conclusions: Therapeutic needle aspiration as well as continuous catheter drainage both are equally effective in management of liver abscess but needle aspiration had the advantage of being less expensive, easily available and requiring less hospital stay.

2021 ◽  
pp. 76-77
Author(s):  
Samir Kumar ◽  
Manish Manish

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.


Author(s):  
RK Vineeth Kumar ◽  
Ashish Pratap Singh ◽  
Ashish Singh ◽  
Priyank Sharma

Introduction: India has second highest incidence of liver abscess worldwide. Image guided drainage methods are increasingly used to treat liver abscesses with fairly high success rates and with low cost and patient preference. But to choose a preferred one among these two methods of Percutaneous Catheter Drainage (PCD) and Percutaneous Needle Aspiration (PNA) still is a dilemma. Aim: To compare the effectiveness and outcome of PCD and PNA in treatment of liver abscess. Materials and Methods: A prospective cohort study was conducted on 150 liver abscess patients in Shyam Shah Medical College in Vindhya region Rewa, Madhya Pradesh, India, from June 2019 to May 2020. They were divided into two groups PNA (n=75) and PCD (n=75) by simple randomisation. Patient outcome was on the basis of duration to attain clinical relief (assessed subjectively), duration of hospital stay and days required for reduction in cavity size below 50%, death, and success rates were assessed in terms of number of attempts for adequate pus drainage. Chi-square test, non-paired Student’s t-test and ANOVA tests were used. Results: In this study mean age was 40.57 years with 92.67% males. Most common lobe to involved was right lobe (87.3%). E.coli was the most common organism. All patients in PCD group were successfully treated in a single attempt. PNA group had a success rate of 84%. Mean number of days of clinical improvement were less for PCD (mean was 5.27 days) than PNA group (mean was 7.49 days) p-value=0.002. Mean days required for reduction in cavity size to less than 50% was lower in PCD (mean was 7.20 days) than PNA group (mean was 8.75 days) p-value=0.01. Total duration of hospital stay was higher in PNA (mean was 11.59 days) than in PCD group (mean was 9.28 days) p-value=0.03. All multiloculated cavities in PNA group were failures. Conclusion: PCD method was found to be more efficacious than needle aspiration method in this study.


2021 ◽  
Vol 12 (7) ◽  
pp. 82-87
Author(s):  
Bhavika Jain ◽  
Nikita Mantri ◽  
Rishika Saraf ◽  
Shivaji Pole ◽  
Devidas Baburao Dahiphale ◽  
...  

Background: Liver abscesses are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. These abscesses are usually suspected clinically in cases having fever and tender hepatomegaly. The diagnosis is usually confirmed on the basis of imaging such as ultrasound and computerised tomography. Management includes antimicrobial agents and drainage of abscess. Percutaneous drainage of abscess is done using needle aspiration or catheter drainage. Aims and Objective: The main aim of the study was to evaluate the role of pigtail catheterization drainage procedure as a treatment option in cases of liver abscess. Materials and Methods: It was a prospective study conducted ata tertiary care medical college. Fifty patients having hepatic abscess were included in this study over a period of one year from August 2018 to September 2019 on the basis of a predefined inclusion and exclusion criteria. These patients underwent pigtail catheterization of liver abscess as a treatment. The demographic characteristics, hepatic lobe involvement, offending organisms and complications were studies in these patients. Results: Out of 50 patients 35 were male and 15 were femalewith a M: F ratio of 1:0.42. The age ranged from 4 years to 92 years. The mean age of the studied cases was found to be 38.64 +/- 18.17 years. Right lobe was involved in predominant cases. most common individual organism involved in hepatic abscess formation was klebsiella (30%) followed by streptococcus (20%) and E-coli (8%) organisms. Seven patients developed procedure related complications out of which 5 patients had catheter dislodgment requiring repositioning of catheter 1 patient developed pus discharge from catheter site and remaining 1 patient developed subcapsular hematoma. Conclusion: Percutaneous image guided pigtail catheter of liver abscess is an effective minimal procedure as a treatment option for liver abscess with high success rate with no mortality related to procedure.


2017 ◽  
Vol 4 (8) ◽  
pp. 2572
Author(s):  
Anshul Siroliya ◽  
Mahendra Damor ◽  
M. C. Songra

Background: This prospective observational study is carried out to study cases of liver abscess and to determine demographic profile, spectrum of clinical presentations, aetiology, laboratory investigations. The objective of the study was to evaluate efficacy of Ultrasonographic (radiological) studies in determining the aetiology and in differentiating from other liver pathologies which may change the treatment outcome, bacteriological and serological characteristics, to study the influence of alcohol, diabetics and immunocompromised diseases (esp. HIV) leading to increased incidence of liver abscess and to evaluate efficacy, recurrence rate, complications, morbidity and mortality, duration of hospital stay associated with different management Strategies.Methods: This prospective observational study was carried out in Department of Surgery, Gandhi Medical College Bhopal and Associated Hamidia Hospital, Bhopal between July 2015 to October 2016.Results: Amoebic abscess (74%) is more common than pyogenic abscess (26%). Amoebic abscess is common in the age group of 31-50 years (73%), pyogenic in the age group of 51-70 years (73.1%). Male preponderance is found in case of amoebic liver abscess (90.5%). Right lobe involvement in common. Right upper quadrant pain, tenderness and fever are the most common clinical features. Alcoholism is most common risk factor (71.6%) and diabetes mellitus has strong association with pyogenic liver abscess (15.4%). E coli (19.2%) and klebsiella (11.5%) are the most common organisms cultured. Medical therapy is more useful in case of amoebic liver abscess (58.1%) while catheter drainage is more useful in case of pyogenic liver abscess (61.5%). Pleuropulmonary complications are much more common and complications rate is more common among pyogenic group.Conclusions: In our study, alcohol was found to be the most common predisposing factor for liver abscesses (68%), this underpin the finding of other studies. Amoebic liver abscess is a medically treated common infection prevailing in unhygienic condition, affecting people mostly between 30-40 years of age whereas pyogenic liver abscess patient commonly falls between 50-70 years age group. Both liver abscesses show a male preponderance. The present study also corroborates the catheter drainage procedure as a superior modality in treating pyogenic liver abscess.


Hepatology ◽  
2004 ◽  
Vol 39 (4) ◽  
pp. 932-938 ◽  
Author(s):  
Simon C.H. Yu ◽  
Simon S.M. Ho ◽  
Wan Y. Lau ◽  
Deacons T.K. Yeung ◽  
Edmund H.Y. Yuen ◽  
...  

2017 ◽  
Vol 24 (01) ◽  
pp. 89-94
Author(s):  
Muhammad Umar Javed ◽  
Sidra Aleem ◽  
Sheraz Jamil Asif ◽  
Javed Iqbal

Objectives: To compare the recurrence rate between incision drainage andmultiple needle aspiration for breast abscess treatment. Study Design: Randomized ControlledTrial. Setting: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur. StudyDuration: 29th September 2015 to 29th June 2016. Materials & Methods: A total of 60 femalepatients with breast abscess of <2 cm in size and of duration <2 weeks between 20 to 40 yearsof age were included. Patients with multiple breast abscesses, recurrent breast abscesses andcomplicated abscesses were excluded. The patients were randomized into Group A (incisionand drainage) & Group B (needle aspiration), by using lottery method. Follow up was done forup to 7 days and recurrence was noted. Results: The mean age of patients in group A was30.83 ± 5.67 years and in group B was 31.53 ± 5.73 years. Mean duration of disease was 7.58± 2.83 days. Mean size of abscess was 0.86 ± 0.43 cm. Recurrence was found in 07 (23.33%)patients in group A (incision drainage) while in 21 (70.0%) patients in group B (multiple needleaspiration) with p-value of 0.000 which is statistically significant. Conclusion: The recurrencerate is less after incision & drainage as compared to multiple needle aspirations for treatingbreast abscess.


2017 ◽  
Vol 8 (4) ◽  
pp. 506-509
Author(s):  
Mallesh Pawar ◽  
◽  
Vinay G ◽  
Sunil Kumar A.P.V ◽  
◽  
...  

2018 ◽  
Vol 17 (2) ◽  
pp. 258-262
Author(s):  
Samita Singal ◽  
Amit Mittal ◽  
Muzzafar Zaman ◽  
Rikki Singal

Aims and objectives: to see the efficacy of ultrasonography in the management of amoebic liver abscess. We assessed whether patient required surgery or can be managed with drainage procedure on ultrasonography basis.Materials and Methods: This is a prospective study done from July 2014 to May 2015, in a medical college in remote area. A total of 88 patients diagnosed with liver abscess were included in the study for ultrasound-guided percutaneous aspiration or pigtail drainage management. All patients had been treated with antibiotics or antimicrobials for at least 2 weeks if treated conservatively and were still being continued for another 6 weeks.Results: A total of 88 patients with liver abscess were successfully treated, consisting 79 males and 9 female. The age ranged from 18 to 82 years with a mean of 43.6 years. A total number of 76 (86.36%) cases undergone percutaneous catheter drainage and 12 (13.6%) underwent needle aspiration. A total of 73 (82.95%) patients had single large abscess, while 8 (9%) had two and 7 (7.9%) had multiple abscesses. The abscesses were commonly located on the right lobe of liver. The Pigtail catheters of sizes 10 F to 18 F was introduced either directly under the guidance of the guide wire with safety precautions. The volume of pus aspirated averaged from 70 - 1200 ml, while the period of catheter drainage ranged from 7 to 24 days with the follow up on ultrasonography.Conclusion: This study shows a success rate of ultrasonography almost 98 % by avoiding unnecessary surgical intervention. It was confirmed that needle aspiration in small abscesses and catheter drainage in large abscesses offers the safest and best modality.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.258-262


2019 ◽  
Vol 7 (2) ◽  
pp. 25
Author(s):  
Ajay Chauhan ◽  
Yashasvi Patel ◽  
P. P. Sharma ◽  
F. S. Mehta

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