Percutaneous debridement of complex pyogenic liver abscesses: technique and results

Abstract

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous de-bridement utilizing an instrument specifically constructed for that purpose. Four patients were chronically ill but stable. Two patients were septic, hypotensive and considered life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. In all cases a contrast-enhanced CT of the abdomen revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases resulting in complete healing in 4–12 days. Follow-up for periods of between 1 and 4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well-developed external capsule and internal septations and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses.

This preliminary experience allows the conclusion that percutaneous debridement of pyogenic liver abscesses can be safely performed, can be curative in selected patients with chronic abscesses and may be lifesafing in critically ill and life-threatened patients.