Percutaneous drainage of lung abscess

Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6-12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess.     

Percutaneous drainage of lung abscess

Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6–12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess.     

Percutaneous drainage of lung abscess.

The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.     

Percutaneous abscess drainage

We have drained 50 abscesses in 40 patients. The success rate was 100% for entering the abscess cavities and 98% for establishing catheter drainage. The success rate for treating the abscess (i.e., no surgery required) was 88%. We drained all abscesses for which a safe access route was available, regardless of the abscess's characteristics. Abscesses which are not unilocular may be successfully treated by percutaneous drainage. In critically ill patients and those unsuitable for surgery, catheter drainage is useful until the patient becomes stable. When surgery is not feasible, percutaneous procedures may be the patient's only hope for survival.     

Percutaneous drainage of appendiceal abscess

Twenty-seven consecutive patients with ultrasonically verified appendiceal abscesses, measuring from 2 to 10 cm in diameter, were studied. Ultrasonically guided percutaneous drainage was performed in 19 by means of one to five punctures, and in eight with one or two catheters. In 16 and 7 patients, respectively, the abscesses resolved without further intervention. Four patients were operated on, two for suspected (but unverified) abscess perforation, one for bowel obstruction, and one because of failed drainage, resulting in a success rate of 85 percent. Hospitalization ranged from 3 to 23 days; however, normal sonograms were not obtained until after nine to 62 days. Follow-up revealed no diagnostic errors. Two patients (8 percent) had recurrent appendicitis, and late sequelae were observed in four patients, three of these after surgery. Ultrasonically guided percutaneous drainage of appendiceal abscesses with the technique described is indicated whenever feasible, as a safe, gentle, and relatively atraumatic procedure with few complications and late sequelae.     

Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.     

Hepatobronchial fistula with percutaneous pyogenic abscess drainage of the liver

Percutaneous abscess drainage has been successfully used in the treatment of hepatic abscesses. We present a case of a posttraumatic pyogenic liver abscess treated by CT-guided percutaneous catheter drainage with an unusual complication of a hepatobronchial fistula. Patient management and the subtle roentgenographic features of this case are presented. Early signs of hepatobronchial fistula including paroxysms of coughing and a peculiar metallic taste during the performance of an abscessogram are reported.     

Percutaneous drainage of liver and splenic abscess

42 patients with solitary (n = 34) and multiple (n = 8) abscesses of the liver (n = 36) and the spleen (n = 6) were treated with ultrasound guided percutaneous interventions. 38 patients (90%) underwent a total of 97 closed abscess aspirations using needles of 0.9 and 1.3 mm in diameter. In 4 cases (10%) percutaneous catheter drainage was performed. Intravenous antibiotics were used in all cases. Those patients with closed abscess aspiration additionally received local injection of aminoglycosides into the cavity. 40 out of the 42 patients could be treated successfully by percutaneous methods for a cure rate of 95.2%. Percutaneous drainage failure occurred in 2.4%. One patient with multiple liver abscesses and catheter drainage died from myocardial infarction (hospital mortality 2.4%). Complications of ultrasound-guided interventions included two minor bleedings, requiring no therapy, and one pleural empyema (complication rate 7.1%). There were no treatment related lethal complications. These results indicate that abscesses of the liver and the spleen up to 10 cm in diameter can be effectively treated by closed (repetitive) needle aspiration and antibiotic therapy with a relatively low rate of complications. About half of our patients with abscesses of more than 10 cm received percutaneous catheter drainage. On the basis of our experience surgical drainage of liver abscesses and splenectomy in splenic abscesses should be restricted to those cases with percutaneous drainage failure.     

Percutaneous drainage of iliopsoas abscess in Crohn's disease

Iliopsoas abscess is a rare but serious complication of Crohn's disease. Initial treatment by surgical drainage of the abscess alone or in combination with bowel resection has been recommended. Percutaneous catheter abscess drainage (PAD) has not been described. We report 3 patients with this uncommon complication of Crohn's disease in whom PAD was attempted. It was successful in 2 cases but failed in 1, who went on to have the abscess drained surgically. We suggest that PAD can be a useful initial treatment to improve the patient's condition prior to definitive surgical resection.     

Percutaneous catheter drainage in drug-resistant amoebic liver abscess

This communication records our experience with the percutaneous catheter drainage (PCD) of 22 amoebic liver abscesses in 19 patients who had failed to respond to amoebicidal therapy. In one patient with a left lobe abscess, imminent rupture was an additional indication for drainage. PCD combined with amoebicidal therapy not only expedited recovery, but was curative in all 19 patients. There were no complications. We conclude that PCD is a most useful adjunct to drug therapy and recommend its routine use in the management of drug-resistant amoebic liver abscesses.     

Percutaneous drainage of tuberculous abscess of the psoas muscle

Two cases of tuberculous abscess of the psoas muscle are reported which did not improve with antituberculosis chemotherapy. They were treated by sonographically guided percutaneous drainage through a pigtail catheter, with a successful result.     

Percutaneous drainage of peridiverticular abscess followed by primary sigmoidectomy

This case report discusses the treatment of a large peridiverticular abscess by sonography-guided percutaneous catheter placement. Primary sigmoid resection was performed successfully at a later time.     

Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery

Intra-abdominal abscesses are a frequent source of morbidity and mortality following both elective and emergent surgery of the alimentary tract. CT-guided percutaneous drainage of intra-abdominal abscess is an alternative to immediate surgical intervention. We studied the clinical characteristics and outcomes of patients undergoing percutaneous drainage of intra-abdominal abscesses arising after elective colorectal procedures. We retrospectively identified 40 patients with postoperative intraabdominal abscess following elective colorectal surgery who underwent CT-guided percutaneous drainage with a Von Sonnenberg sump drain between 1990 and 1998. The most common presenting symptoms were pyrexia in 39 (97%), abdominal tenderness in 32 (80%), guarding in 1 (2.5%) and abdominal mass in 3 (7.5%); no patient had generalized peritonitis. The most common index procedure was proctocolectomy with ileoanal anastomosis and ileal Jpouch in 12 (30%) patients. Drainage was performed using an anterior approach in 32 (80%) and a transgluteal window in 8 (20%) patients. Thirty-five (87.5%) patients had a single collection, while 2 (5.0%) patients had 2 collections and 3 (7.5%) patients had 3 collections. Thirteen (32.5%) patients had perioperative steroids, 30 (75%) had preoperative antibiotics, and 40 (100%) had postoperative antibiotics. Follow-up at a mean of 35.8 days revealed complete resolution of abscess in 26 (65%) patients; 14 (35%) patients had residual or recurrent abscess successfully treated by repeat drainage in 8 patients and requiring laparotomy in 6. Percutaneous CT-guided abscess drainage is an effective method for treating intra-abdominal abscess following elective colorectal surgery. The primary success was 65% after the first and 85% after a second drainage. In conclusion, this technique should be considered as the treatment of choice in patients with localized intra-abdominal abscess without signs of generalized peritonitis. Received: 20 July 2002 / Accepted: 4 November 2002     

Multiple pyogenic liver abscess

Multiple pyogenic liver abscesses have been rarely described. We report a fatal case of multiple pyogenic liver abscesses affecting a 38-year-old woman requiring surgical drainage. Evolution was marked by occurrence of a septic shock with multi-organ system failure. The patient died 48 h after surgery. Causes, therapeutics and outcome of the disease are discussed.     

超声引导下经皮穿刺抽吸冲洗术治疗化脓性肝脓肿临床研究

目的 研究超声引导下经皮穿刺抽脓治疗化脓性肝脓肿（PLA）患者的疗效。方法 2014年6月～2016年6月收治PLA患者60例,30例接受穿刺抽脓,另30例接受置管排脓。观察临床治疗效果。结果 在60例PLA患者脓液中,培养发现细菌阳性34例（56.7%）,获得致病菌43株,其中变形杆菌1株（2.3%）,肺炎克雷伯杆菌29株（67.4%）,表皮葡萄球菌1株（2.3%）,大肠埃希菌5株（11.6%）,粪肠球菌2株（4.7%）,金黄色葡萄球菌5株（11.6%）;在23例血培养患者,发现与脓液相同细菌阳性6例（26.1%）;穿刺抽脓和置管排脓患者脓腔消失时间分别为[（9.18±1.84）d和（12.57±1.67）d,P＜0.05],体温恢复正常分别为[（2.18±0.52）d和（2.24±0.59）d,P＞0.05],住院日分别为[（12.84±1.97）d和（12.04±1.78）d,P＞0.05],医疗费用分别为[（13982±1604）元和（16007±1657）元,P＞0.05]。结论 两种抽脓方法治疗PLA患者疗效显著,操作简单易行,风险小,且术后基本无并发症发生。     

A case report of a lung abscess as a rare complication of a pyogenic liver abscess

Rationale:A hepatobronchial fistula and lung abscess following a pyogenic liver abscess is a rare entity and it is not easy to diagnose this condition based on the symptoms and chest radiography.Patient concerns:An 81-year-old man presented with productive cough and dyspnea.Diagnosis:Chest radiography indicated increased opacities in the right lower lung field with an air-fluid level suggestive of pneumonia complicated by a lung abscess. Chest and abdominal computed tomography revealed an abscess in the right lower lung field that bordered an abscess at segment 7 of the liver. Tubography confirmed a fistula between the liver and lung abscesses.Interventions:Due to communication between 2 abscesses, transhepatic approach was done instead of transpleural approach to avoid complications.Outcomes:A liver abscess complicated by a lung abscess was resolved following percutaneous transhepatic drainage of the liver abscess and antibiotic administration.Lessons:Though uncommon, the lack of suspicion of sub-diaphragmatic liver abscess often lead to a delay in diagnosis and proper treatment. Our case implies the importance of computed tomography in early diagnosis of liver abscess in case of lung abscess in the right lower lung field.     

A case of hepatocolic fistula after percutaneous drainage for a gas-containing pyogenic liver abscess

We describe a rare of gas-containing pyogenic liver abscess which penetrated the adjacent colon, forming a hepatocolic fistula, after percutaneous transhepatic abscess drainage (PTAD) had been performed. To the best of our knowledge, this is the first report of hepatocolic fistula associated with a gasforming liver abscess in a diabetic patient, with radiological and surgical confirmation of the fistula.