Percutaneous treatment of large pyogenic liver abscess

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 either via needle aspiration or percutaneous catheter drainage (CD). There is a debate about which is better intermittent needle aspiration or CD. Our objective is to compare the outcome of CD versus intermittent needle aspiration of pyogenic liver abscess and to compare the single step Trocar technique versus the modified Seldinger technique. 88 patients, 65 men and 23 women, mean age 44.6 (18–73) years had pyogenic liver abscess. Patients were divided in two groups randomly; aspiration group with maximum of three attempts and the CD group. Ultrasound or CT was used. Aspiration was successful in 60% of cases (26/43). CD was successful in 98% (44/45). Three patients were treated by surgical drainage (two patients of the aspiration group and one of the CD group) with favorable outcome. Both Seldinger and single step Trocar techniques were comparable as regards outcome and procedure-related pain but the procedure time of Trocar was significantly shorter. No major complications were encountered. CD is more efficient than needle aspiration. Aspiration can be used for simple small abscesses. Trocar technique is less time-consuming than the Seldinger technique.