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Percutaneous drainage of liver abscess with ultrasound guidance.
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Background: Liver abscess is a common problem among children. The purpose of this study is to describe the etiology, different management strategies and outcome of children with liver abscess in Children's Hospital Lahore. Conclusions: In our pediatric population, liver abscess are mostly caused by pyogenic organisms. Amebic etiology was not proven...
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There are only 11 cases of caudate lobe liver abscess drainage described in the published literature. We present a case of liver abscess drainage done by endosonography (EUS) and review of various EUS-guided liver abscess drainage techniques and endoprostheses. Here we have aimed at reviewing the data for paving the way for the development of a con...
Citations
... Liver abscess is a pus-filled encapsulated mass in the liver parenchyma caused by a trauma or infection; bacterial, fungal, or parasitic microorganisms spread via the portal circulation (1,2). The most common type of liver abscess is bacterial, with Klebsiella pneumonia and Escherichia coli as the primary pathogenic microorganisms, followed by amebic liver abscesses (3)(4)(5). Cryptogenic abscesses, with unknown etiology, also represent about 20% of liver abscess (1,3). The incidence of liver abscess varies from 1.0 to 3.6 per 100,000 in Western nations (5), but it may rise up to 17 per 100,000 in Asia (6). ...
... The most common type of liver abscess is bacterial, with Klebsiella pneumonia and Escherichia coli as the primary pathogenic microorganisms, followed by amebic liver abscesses (3)(4)(5). Cryptogenic abscesses, with unknown etiology, also represent about 20% of liver abscess (1,3). The incidence of liver abscess varies from 1.0 to 3.6 per 100,000 in Western nations (5), but it may rise up to 17 per 100,000 in Asia (6). ...
... The Abscess pathogenesis, clinical features, and patient overall status should be considered during the management. Generally, both antibiotic intervention and sufficient drainage are essential for managing liver abscess (1,3,10). The selected antibiotics should be effective against the most prevalent pathogens and until cultural results appear, empirical treatment should be started. ...
Background:
Liver abscess is a life-threatening condition. Percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) are both minimally invasive techniques used to manage liver abscess. We aim to compare both techniques' efficacy and safety.
Methods:
We performed a systematic review and meta-analysis involving randomized controlled trials (RCTs) from PubMed, Embase, Scopus, WOS, Cochrane, and Google scholar until July 22nd, 2022. We pooled dichotomous outcomes using risk ratio (RR) presented with a 95% confidence interval (CI) and continuous outcomes using mean difference (MD) with 95% CI. We registered our protocol with ID: CRD42022348755.
Results:
We included 15 RCTs with 1,626 patients. Pooled RR favored PCD (RR: 1.21 with 95% CI: 1.11, 1.31, P<0.00001) in success rate and recurrence after six months (RR: 0.41 with 95% CI: 0.22, 0.79, P=0.007). We found no difference in adverse events (RR: 2.2 with 95% CI: 0.51, 9.54, P=0.29). Pooled MD favored PCD in time to clinical improvement (MD: -1.78 with 95% CI: -2.50, -1.06, P<0.00001), time to achieve 50% reduction (MD: -2.83 with 95% CI: -3.36, -2.30], P<0.00001) and duration of antibiotic needed (MD: -2.13 with 95% CI: -3.84, -0.42, P=0.01). We found no difference in the duration of hospitalization (MD: -0.72 with 95% CI: -1.48, 0.03, P=0.06). The results were heterogeneous for all the continuous outcomes which were all measured in days.
Conclusions:
Our updated meta-analysis concluded that PCD is more effective than PNA in liver abscess drainage. However, evidence is still uncertain, and more high-quality trials are still required to confirm our results.
... In presenting study, 53.12% (17/ 25 . However small Abscess <50 mm and large abscess >50 mm Were best managed by conservative alone and USG guided percutaneous aspiration respectively 19,20,24 . So, management of PLA whether by conservative or percutaneous treatment or both is still in debate and that is depends on size of LA, single or multiple and lack of antibiotic response in form of clinical sign of persistent sepsis or enlarging abscess. ...
In developing country like India, liver abscess in children is mostly pyogenic (PLA) in nature. This article aimed to analyze detail parameters of LA of admitted cases in tertiary care hospital of Ahmedabad city. Details of 32 patients From1 month to 14 years age groups were assessed retrospectively over periods of 2 years. The demographic profile, clinical presentation, laboratory and ultra sonographic, microbiological profile, management and outcome of patients were retrieved from case records. All cases had PLA with mean age 6 years and male predominance (64.28%). Under nutrition and enteric fever were only risk factors derived. Fever (93.75%) and abdominal pain (68.75%) were commonest presentation of LA. Leukocytosis found in 62.5% cases with neutrophilic predominance. Majority of LA were single (90.6%), in right lobe of liver (68.8%) with more than 50mm in size. Positivity rate of pus and blood culture in 12.5% and 15.62% cases respectively where staphylococcus aureus is commonest organism.17 cases (53.12%) require antibiotics treatment alone ,14 cases (43.75%) USG guided needler aspiration and 1 case (3%) open surgical drainage with 100%recovery rate. PLA is commonest in children and cryptogenic in origin. Management of LA required multidisciplinary approached include antibiotic and/or USG guided percutaneous needle aspiration.
... Surgical drainage may be necessary in patients with abscess rupture and peritonitis, with large multi-loculated abscesses > 5 cm in size, who do not respond to antibiotics or percutaneous drainage, with concomitant biliary pathology. 16 Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broadspectrum antibiotics and imaging-guided percutaneous drainage either via needle aspiration or percutaneous catheter drainage (PCD). There is a debate about which is better intermittent needle aspiration or PCD. ...
BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children
... 22 A report showed that antimicrobial therapy alone was effective for small abscesses, while percutaneous needle aspiration or draining should be chosen for larger abscesses. 23 A study reported that liver abscesses due to K. pneumoniae that were >5 cm were likely to have a delayed response to therapy. 24 In the present study, the liver abscess was <5 cm (35×27 mm) and this hvKP strain was sensitive to all antibiotics. ...
Rationale
Klebsiella pneumoniae (K. pneumoniae, KP) are divided into two types: classic K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP). hvKP causes liver abscess and metastatic infection. Here, we report one case with pyogenic liver abscess (PLA) and endogenous endophthalmitis (EE) due to a relatively rarely reported serotype of K. pneumoniae in China.
Patient Concerns
An 80-year old man presented with nausea, vomiting, and epigastric discomfort for 2 weeks.
Diagnoses
PLA was identified by CT scan and abdominal ultrasound. Urgent ophthalmologic consultation was performed. B-scan ocular ultrasound was done and he was diagnosed as EE.
Interventions
Antibiotic treatment, intravitreal injection of eyes and eye drops were given. Percutaneous needle aspiration, evisceration, and drainage of the right eye were performed.
Outcomes
Cultures of the blood, the aspirated pus from the liver abscess, and the contents of the eyeball all yielded K. pneumoniae with a positive string test. The capsular serotype was K64. According to the existence of multiple virulence genes and the severe invasive clinical manifestation, this strain is regarded as a hvKp strain. Multilocus sequence typing (MLST) revealed the sequence type (ST) of this strain was K64-ST1764. Antimicrobial resistance genes, blaNDM-1 and blaKPC-2, were not detected in the genome. The patient lost his eyesight but his symptoms subsided. During 15 months follow-up, the result was satisfactory.
Lessons
Here, we report one case with PLA due to a relatively rarely reported serotype of K. pneumoniae in China. This K64 K. pneumoniae strain is confirmed as hvKp by multiple methods. It is noteworthy that the sequence type is K64-ST1764 instead of the commonest ST11. Moreover, this strain is not considered a K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) or a carbapenem-resistant K. pneumoniae (CRKP) as it is usually. Further follow-up and research are required to investigate this strain.
... The most common type is the pyogenic abscess (incidence: 3 cases/100,000 people/year), followed by amoebic abscess, which accounts for only 3%-9% of all cases of liver abscess in developing countries. [113] In the index study, both liver abscesses identified were pyogenic abscesses. Male are commonly affected (3.3 vs. 1.3 per 100,000). ...
Context:
Cysts arising from the hepatobiliary tree are a group of heterogeneous lesions with regard to pathogenesis, clinical presentation, and radiological finding. They can be intrahepatic or extrahepatic, developmental, secondary to infective/inflammatory etiologies, as well as neoplastic. This study was conducted to determine the spectrum of hepatobiliary cysts in surgically intervened cases, with regard to their prevalence, histological spectrum, and clinicoradiological correlation, wherever possible.
Methods:
In this retrospective observational study, hematoxylin and eosin stained slides of all cases of hepatobiliary cystic lesions, operated between 2009 and 2016 were reviewed. Special stains as reticulin, Masson's trichrome, and periodic acid Schiff were done wherever necessary. Overall prevalence, age-sex distribution, clinical presentation and histopathological patterns were studied. Relevant imaging findings were correlated wherever possible.
Results:
A total of 312 cases of hepatobiliary cysts were identified, the majority in females. Choledochal cysts (CCs) were the most common type (n = 198,63.5%), followed by hydatid cysts (n = 73,23.3%), simple hepatic cysts (n = 10,3.2%), congenital hepatic fibrosis (n = 10,3.2%), biliary cystadenomas (n = 4,1.2%) hepatic mesenchymal hamartomas (n = 7,2.2%), and cavernous hemangiomas (n = 3,0.9%). Fibropolycystic liver disease (n = 2,0.6%), Caroli's disease (n = 1, 0.3%), liver abscess (n = 2, 0.6%), infantile hemangioendothelioma (n = 1,0.3%), and biliary cystadenocarcinomas (n = 1,0.3%) were rare. Lesions noted mostly in 1st decade of life were: CCs, fibrocystic liver disease, Caroli's syndrome, cystic mesenchymal hamartoma, and infantile hemangioendotheliomas.
Conclusion:
In our cohort of surgically intervened cases of hepatobiliary cystic lesions from a tertiary care hospital in North India, the CCs, followed by hydatid cyst were the most common lesions. Histology can play vital role in characterization, as often clinical findings and radiology can overlap.
... Our result showed that medical management alone and in combination with PNA was successful in the majority of patients (n = 114, 74.02%) which was similar to the results of Cheema et al. [22]. Repeated needle aspirations were often required in our patients. ...
Aim:
Although liver abscess (LA) is prevalent worldwide, especially in developing countries, there is a paucity of data regarding the protocol for management of LA in children. The aim of this study was to analyze the outcome of a protocol-based management of pediatric LA from a single institution.
Materials and methods:
This prospective observational study was conducted in a tertiary-care children's hospital and included all patients with LA managed over a 5-year period. Detailed clinical, laboratory, microbiological and imaging parameters were recorded, and the patients were treated according to a standardized management protocol. Small abscesses (<5 cm) and those with solid appearance on initial ultra-sonogram (US) were managed with antimicrobial therapy alone. Liquefied abscesses on imaging were additionally subjected to US guided percutaneous needle aspirations (PNA). Large abscesses pointing to the surface were treated by percutaneous drainage (PCD). Ruptured LA, abscess inaccessible to image-guided drainage and those not responding to other modes of treatment were subjected to open surgical drainage (OSD). Pleural collections were treated by aspirations or intercostal tube drainage. Outcome was analyzed in terms of duration of recovery and complications including mortality.
Results:
Over the 5-year period, 154 pediatric LA patients underwent protocol-based management. The mean age of the patients was 6.76 years with the male:female being 1.26:1. Medical management alone, PNA, PCD and OSD were successful in 38 (24.6%), 76 (49.3%), 11 (7.14%) and 29 (18.8%) cases, respectively. Pleural collections developed in 43 (27.9%) patients out of which aspiration/drainage was needed in 24 (55.81%) cases. The mean duration of hospital stay was 20.67 ± 9.52 days. Ongoing sepsis and multi-organ failure lead to mortality in 6 (3.8%) cases; rest of the patients were doing well on follow-up.
Conclusion:
Ultra-sonography was useful for the initial diagnosis, monitoring the progress and management of LA in children. The outcome of a protocol-based management of LA in children was favorable.
... The two most common varieties of liver abscess are pyogenic and amoebic. 1 Amoebic liver abscess is an important cause of space-occupying lesions of the liver; mainly in developing countries accounted for 3-9% of all cases of amoebiasis. 2 This infection is caused by the protozoa E. histolytica, which ascends the portal venous system. Liver abscesses are the most common type of visceral abscess; in one study of intraabdominal abscesses, pyogenic liver abscesses accounted for 48% of visceral abscesses and 13% of intraabdominal abscesses. ...
... We noted similar presenting symptoms with fever, abdominal pain and vomiting being the common presenting features and there was male and right hepatic lobe predominance. 1,2,[4][5][6][7]9 Of note, the mean age of the population in this study (47.4 ± 18.5 yrs) was younger than that of other reports, which shows an upward shift in age range. 5,7,10,11 The reasons for this are obscured but can be explained partially by Qatar and other Gulf countries having large working communities composed mainly of temporarily immigrant, predominantly Asian, unaccompanied young males. ...
Objective:
To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar.
Methods:
A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from January 1, 2009, to December 31, 2010. Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture.
Results:
In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 (91%) males and six (9%) females and their mean age was 47.4 ± 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 (79%) patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients (38%). The mean duration of hospitalization was 13.6 ± 8.1 days; the mean duration of antibiotic therapy was 34.7 ± 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 ± 4.1 days, mean duration of therapy was 11.8 ± 2.1 days, and all patients were cured.
Conclusion:
Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical intervention was unnecessary in almost all the cases.
... The two most common varieties of liver abscess are pyogenic and amoebic. 1 Amoebic liver abscess is an important cause of space-occupying lesions of the liver; mainly in developing countries accounted for 3-9% of all cases of amoebiasis. 2 This infection is caused by the protozoa E. histolytica, which ascends the portal venous system. Liver abscesses are the most common type of visceral abscess; in one study of intraabdominal abscesses, pyogenic liver abscesses accounted for 48% of visceral abscesses and 13% of intraabdominal abscesses. ...
... We noted similar presenting symptoms with fever, abdominal pain and vomiting being the common presenting features and there was male and right hepatic lobe predominance. 1,2,[4][5][6][7]9 Of note, the mean age of the population in this study (47.4 ± 18.5 yrs) was younger than that of other reports, which shows an upward shift in age range. 5,7,10,11 The reasons for this are obscured but can be explained partially by Qatar and other Gulf countries having large working communities composed mainly of temporarily immigrant, predominantly Asian, unaccompanied young males. ...
Objective: To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar. Methods: A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture. Results: In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 (91%) males and six (9%) females and their mean age was 47.4 ± 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 (79%) patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients (38%). The mean duration of hospitalization was 13.6 ± 8.1 days; the mean duration of antibiotic therapy was 34.7 ± 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 ± 4.1 days, mean duration of therapy was 11.8 ± 2.1 days, and all patients were cured. Conclusion: Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical intervention was unnecessary in almost all the cases.
Pyogenic liver abscess (PLA) is an infrequently seen complication of appendicitis that once was common, but now is so rare many textbooks omit the condition entirely. In this report, we document a recent case of post-appendicitis PLA in an eight-year-old Hispanic female treated with a combination of medical and surgical management. We have detailed the course of treatment, both to raise awareness of this uncommon complication of appendicitis and to help provide a guide for other clinicians treating similar cases. While cases of pediatric PLA post-appendicitis are rare in the modern world, timely diagnosis and treatment of the lesions are paramount to patient recovery and prevention of long-term sequelae. Study of prior literature and research is likely to be of vital importance to the treatment of the condition. Multiple treatment modalities may be considered, and there is no true standard of care for pediatric populations presenting with PLA.
Background: The aim of this study was to determine and compare the therapeutic effectiveness and safety of USG guided percutaneous continuous catheter drainage and USG guided percutaneous needle aspiration in the treatment of liver abscess in Trichy. Methods: This is a prospective randomised comparative study of 50 patients, presented in outpatient and emergency department at the hospital, randomised equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of their treatment was measured in terms of duration of hospital stay, time taken for improvement of clinical symptoms, time taken for 50% reduction in cavity size and total or near total reduction of abscess cavity. Independent t-test was used to analyse these parameters. Results: The success rate was significantly better in catheter drainage group. Patients in pigtail catheter drainage group showed earlier clinical improvement (p 0.000) and 50% reduction in abscess cavity volume (p 0.000) and near total reduction of abscess cavity was earlier (p 0.019) as compared to those who underwent percutaneous needle aspiration. Conclusion: Our study concludes that percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, reduction of cavity and success rate.
