[The conservative treatment of hepatic abscesses with echo-guided transcutaneous drainage].
Liver abscesses are a rare disease with 80-100% mortality in untreated cases. The advent of ultrasound in the clinical practice has improved the prognosis. Surgery for this disease has a percentage of complications of 15-52% and a mortality of 12-33%. In a review of the literature about 200 liver abscesses treated with ultrasound-guided percutaneous drainage the complications were 7.5% and the mortality was 3%. The authors report their personal experience about 21 hepatic abscesses in 13 patients. Nineteen abscesses were treated with ultrasound-guided percutaneous drainage and two with antibiotics. Six patients had pyogenic liver abscesses, two amebic and in five patients the cultures were sterile. In 9 cases the location was in the right lobe of the liver, in 3 was in the left lobe. One patient had multiple abscesses. The size of the abscesses ranged from 0.5 to 13 cm. We drained with Seldinger technique or direct procedure with Trocar's needle under ultrasound guidance without serious complications and without mortality. In 6 cases the patients had pain during the procedure and in 3 cases medical therapy was necessary. In one case we had a pleuritis for the puncture of costophrenic space. All the patients treated had a complete resolution of the abscesses. The ultrasound-guided percutaneous drainage is the treatment of choice for liver abscesses. But other reports with more patients are necessary to clarify the indications and the ultrasound criteria of recovery.
Guglielmi
A
A
Divisione Clinicizzata di Chirurgia Generale, Università degli Studi di Verona.
Veraldi
G F
GF
Furlan
F
F
Brunelli
G
G
de Manzoni
G
G
Negri
A
A
Borzellino
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D008101:Liver Abscess, Amebic / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012074:Remission Induction; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
Il trattamento conservativo degli ascessi epatici con drenaggio transcutaneo ecoguidato.