Liver Abscess Drainage
This section provides a comprehensive procedural report for liver abscess drainage procedure with up-to-date explanatory notes, synopsis of the indications, and contraindications and potential complications in an organized and practical format.
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Bedros Taslakian
INTRODUCTION Liver abscess may be caused by bacteria, fungi, or parasites. Pyogenic liver abscesses do not commonly arise spontaneously but rather occur as a result of ascending infection from sources such as diverticulitis or appendicitis. They can also be seen when there is contamination of the biliary tree with organisms and some degree of bile duct obstruction. Appropriate investigations should be carried out so that the underlying cause can be identified and treated. Pyogenic abscesses are the most common hepatic collections amenable to percutaneous drainage. It is usually performed under ultrasound or CT guidance. Fluoroscopy can be combined with ultrasound or CT to assist with catheter positioning in difficult cases.
COMMON INDICATIONS [1–9] • Pyogenic liver abscess • Infected hydatid cyst not responding to medical therapy >2 weeks • Amebic abscess not responding to medical therapy • Peripheral amebic abscess (more prone to rupture) • Infected biloma B. Taslakian (&) Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY 10016, USA e-mail: [email protected]
COMMON CONTRAINDICATIONS [1–3] Most contraindications are relative. • Significant coagulopathy that cannot be adequately corrected • Sterile collections, such as hepatic hematoma (risk of superimposed infection) • Lack of a safe pathway to access the collection • Procedure requires transgression of pleura (risk of pneumothorax, empyema, fistula, and pleural effusion) • Suspected hydatid (echinococcus) cyst (increased risk of anaphylactic shock due to intra-peritoneal leakage; pre-treatment is required before drainage) • Malignant abscess requiring lifelong drainage • Hemodynamic instability • Inability of the patient to be adequately positioned for the procedure • Pregnancy in cases when imaging guidance involves ionizing radiation
POSSIBLE COMPLICATIONS [1–3] • Major hemorrhage, 1 %; intraperitoneal hemorrhage, subcapsular, or parenchymal hematoma, hemobilia • Bacteremia, 2–5 % • Septic shock, 1–2 % • Pleural transgression requiring intervention, 1 % • Bowel transgression with or without fistula formation or peritonitis, 1 %
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_34
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• Catheter malfunction, due to kinking, blockage, and dislodgment • Pericatheter leak • Mortality
PREPROCEDURAL ASSESSMENT AND PLANNING • History, indications, and physical examination (Appendix 1 in Chap. 149) • Evaluation of diagnostic imaging studies to determine the location of the abscess, its size and relevant anatomy • Periprocedural management of coagulation status (Appendices 2 in Chap. 150 and 3 in Chap. 151) • Antibiotic prophylaxis: Routinely recommended [10] • Imaging modality for guidance: CT, CT fluoroscopy, ultrasound, combined fluoroscopy with CT, or ultrasound [1, 3] • Positioning: Oblique, lateral decubitus, or supine
PROCEDURE NOTE Procedure: Percutaneous drainage of liver
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