title: Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess: Is it worth it?
abstract: OBJECTIVE
  To delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity.
  
  
  METHODS
  Using this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm.
  
  
  RESULTS
  All patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient's condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded.
  
  
  CONCLUSIONS
  LHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient's general condition. This enables treating patients in greater safety and also reduces complications.
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Aylhin J
authors.initials: AJ
authors.lastname: Lopez-Marcano
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ramia
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Arteaga
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: De la Plaza
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Jhonny D
authors.initials: JD
authors.lastname: Gonzales
authors.affiliation: Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
authors.forename: Anibal
authors.initials: A
authors.lastname: Medina
keywords: Abscess; Hydatidosis; Liver; Review; Surgery