Our experiences with the management of pyogenic liver abscesses by percutaneous transhepatic puncture and permanent drainage guided by computed tomography.
Thirty-three patients with pyogenic liver abscess were treated by percutaneous transhepatic puncture or permanent drainage between the period of 1, January 1985 and 31, December 1990. The closed puncture or drainage resulted in the complete recovery of 26 patients (26/33 = 78.8%). Surgical intervention was made 6 +/- 5 days following closed drainage in 7 cases (7/33 = 21.2%). After percutaneous intervention complications ensued in four patients (4/33 = 12.1%). One patient died (1/33 = 3%). Solitary abscess occurred in 24, while multiple in 9 patients. Based on the authors' experiences, they consider the closed percutaneous puncture, or drainage guided by computed tomography--provided that proper shills and facilities are available--them does not enable in all cases the precise preoperative diagnosis even despite its richness of detail. In order to reduce uncertainties and to establish an accurate diagnosis, Herbert et al., McCorrcel et al. and Perera et al. proposed three criteria to be met before establishing the diagnosis of pyogenic liver abscess. According to the authors the conditions for accepting these criteria can be summarized as follows: 1. On the US examination of the liver, echo-free or echo-poor regions can be seen with increased background echoes. CT verifies an inhomogeneous, circumscribed or irregular-shaped, blurred focus of finely deformed contours being hypodense in contrast with the environment. On administration of contrast medium, the change is surrounded by a hyperdense border, and other causes for the above change can be excluded. 2. Verification of the presence of pus (by percutaneous puncture or surgery) from the liver biopsy. 3. The negative result of serological tests characteristic of amoebic infection. CT and US examinations have opened up new vistas not only in establishing diagnosis but also in the management of the disease. The closed percutaneous and effective method in the management of liver abscesses.
Ihász
M
M
3rd Department of Surgery, Semmelweis University Medical School, Budapest, Hungary.
Fazekas
T
T
Todua
F I
FI
Bátorfi
J
J
Máté
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D013492:Suppuration; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography