Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage.

Abstract

Medical therapy is standard for intrahepatic amoebic abscess and generally is effective. However, there is a group of patients in whom percutaneous aspiration and drainage was indicated due to uncertainity of diagnosis or clinical deterioration of the patient. Twenty such patients underwent percutaneous drainage with ultrasound or CT [computed tomography] guidance, and each patient was cured (appropriate antibiotics were administered concomitantly). The specific indications for intervention were to differentiate pyogenic from amoebic abscess, pain and imminent rupture, poor response to medical therapy, false-negative results of serologic tests, noncompliance with medical treatment, left lobe abscess, and pregnancy. Diagnosis of amoebiasis from examination of the fluid was seldom possible, while findings from core biopsy of the wall of the abscess led to diagnosis in 3 cases. Recurrence necessitating redrainage occurred in 3 patients; in each, catheters were removed the same day drainage was performed. There were 3 minor complications. Differences from percutaneous management of pyogenic abscesses included more rapid removal of catheters included more rapid removal of catheters (4 days), more frequent use of US [ultrasound] guidance, and more common use of the prone angled approach to avoid pleural contamination. Catheter drainage may be curative and may expedite care for problematic amoebic liver abscesses in selected cases.