Needle aspiration of liver abscess under ultrasound guidance

Objective: To evaluate efficacy of needle aspiration under ultrasound guidance in liver abscess. Design: It was a prospective case series study. Place and Duration of Study: Liaquat Medical college Hospital, Jamshro/ Hyderabad and the author's private consulting chamber over a period of 10 years for January 01, 1991 to December 31, 2000. Subjects and Method: All the 245 patients with confirmed liver abscess, clinically and on ultrasound, were included in the study, 32 patients having abscesses of > 5 cm size were initially treated conservatively on a combination of cephalosporin, Metronidazole and chlorquin for 7-10 days. The patients not responding to conservative treatment and remaining 213 patients were subjected to needle aspiration under ultrasound guidance local anesthesia for 1-5 times as necessary. Five patients, under 10 years of age, required general anesthesia. They were given metronidazole, cephalosporin and chloroquin for amoebic abscess and 3rd generation cephalosporin for pyogenic abscess. Two patients ultimately required open surgical drainage. Result: Twenty five out of 32 (78%) patients having abscesses of > 5 cm recovered completely on conservative treatment. Of the remaining 220 patients the number of patients requiring one, two, three, four or five aspirations were 102 (46.4%), 62(28.2%), 43(19.5%), 9(4.1%) and 4(1.82%) respectively. There was only one mortality (0.4%), due to hematoma formation in the abscess cavity. Two patients (0.9%) having very large abscesses of >17 cm size required open drainage. Conclusion: I) Abscesses of <5cm can usually be treated conservatively. II) Abscesses of 5-17 cm size can be aspirated 1-5 times as necessary, safely economically and effectively with very little morbidity and mortality. III) Abscesses of > 17cm do not respond to aspiration and should be subjected to open drainage. (author)