| Abstract: | The objective of this case report is to describe a device that can be used as a minimally invasive alternative for the treatment of drainage-resistant liver abscess. The device uses pulse lavage to fragment and evacuate the semi-solid contents of a liver abscess. The treatment of liver abscesses consists of percutaneous drainage, antibiotics and treatment of the underlying cause. This approach can be ineffective if the contents of the abscess cavity are not liquid, and in those cases open surgery is often needed. Here, we describe for the first time a new minimally invasive technique for treating persistent liver abscesses. A patient developed a liver abscess after a hepatico-jejunostomy performed as a palliative treatment for an unresectable pancreatic head carcinoma. Simple drainage by a percutaneously placed pig-tail catheter was insufficient because of inadequate removal of the contents of the abscess cavity. After dilatation of the drain tract the persistent semi-solid necrotic contents were fragmented by a pulsed lavage device, after which the abscess healed uneventfully. The application of pulsed lavage for debridement of drainage-resistant liver abscesses proved to be an effective and minimally invasive alternative to open surgery.The mainstays of the treatment of liver abscesses are drainage and antibiotics. Drainage can be performed by ultrasound- or CT-guided percutaneous drain placement or by surgical techniques using laparoscopy or laparotomy. The most appropriate method of drainage is controversial and varies from open surgery to repeated percutaneous punctures. Surgical drainage had a higher success rate and a shorter hospital stay than percutaneous drainage in a retrospective study of 80 patients with large pyogenic liver abscesses 1]. By contrast, a randomised trial revealed that drainage by repeated puncture was equally as effective as percutaneous drainage in which an indwelling catheter was left behind 2]. For most patients with liver abscesses, percutaneous drainage is an effective treatment.In patients with highly viscid, sticky pus or infected necrotic tissue, it is much more difficult to clean the abscess cavity because of occlusion of the relatively narrow percutaneous drain and inability to remove the semi-solid contents. In these cases, surgery is performed to create a large opening and adequate drainage of the contents of the abscess cavity. Even partial liver resection has been advocated for the treatment of drainage-resistant liver abscesses 3].Here, we describe a new technique that has the potential to treat a non-resolving liver abscess efficiently after simple percutaneous drainage. The technique uses pulsed lavage, which is able to fragment and evacuate non-liquefied debris in a liver abscess using a percutaneous approach. |
