Comparative study of catheter drainage and needle aspiration in management of liver abscesses

Volume : VII, Issue : V, May - 2018

Dr Ajay Kumar Nandmer, Dr Vijay Kumar Nandmer

Currently, there are 2 alternative methods for drainage of pus from a large liver abscess. Percutaneous therapeutic procedures

have been increasingly performed compared with open surgical drainage (SD). Liver abscesses larger than 5 cm are currently

treated by intravenous antibiotics and either percutaneous continuous catheter drainage (PCD) or percutaneous intermittent

needle aspirationThis study aims to compare the therapeutic effectiveness and necessity of ‘Percutaneous continuous catheter

drainage‘ versus ‘Percutaneous intermittent needle aspiration‘ in the percutaneous group of treatment for large liver

abscesses(>10cm size); thus making it the first study in the literature that compares the 2 percutaneous modalities for treatment

of large liver abscesses >10 cm.

The combination of systemic antibiotics and percutaneous drainage has become the treatment of choice for the management of

liver abscesses in most centers. In general, surgical drainage has been reserved for patients who fail to respond to treatment with

percutaneous drainage and antibiotics or who have concurrent intraabdominal pathology which requires surgical management.

With the introduction of high–resolution imaging modalities including US and CT in the recent two to three decades, and advent

of minimally invasive therapy such as image–guided percutaneous needle aspiration or catheter drainage and the availability of

oad–spectrum antibiotics, patients with pyogenic liver abscess nowadays seldom require open surgery for treatment. This shift

of practice has been guided by a drive for minimally invasive therapy whenever possible, and the advantages of avoiding general

anaesthesia and an operative procedure.

Modern treatment has shifted the treatment of liver abscess toward IV oad–spectrum antibiotics and imaging–guided

percutaneous needle aspirationor percutaneous catheter drainage (PCD).

This study includes all the patients with diagnosis of liver abscess, >10cm in size by sonography irrespective of their demographics,

size of liver abscess, causative pathogen, clinical presentation, pretreatment LFT‘s and other blood investigations and concurrent

illness for their treatment by ‘percutaneous intermittent needle aspiration‘ or ‘percutaneous continuous catheter drainage‘ AND

to assess the relative effectiveness and need of either one of these two techniques.

Aims & Objective:

The study aims are:

1. To evaluate efficacy of catheter drainage versus needle aspiration along with medical therapy in management and outcome of

liver abscess.

2. To study other causes which can mimic like liver abscess e.g infected hydatid cyst of liver

3. To assess post procedure complications related to both procedure.

MATERIALS AND METHODS:

4. Study area: department of medical gastroenterology, institute of medical sciences, BHU, VARANASI.

5. Study population: Patients diagnosed having liver abscess based on clinical findings and imaging techniques

6. Study period: August 2015 – July 2016