Rajeev Nayan Priyadarshi1, Vijay Prakash2, Utpal Anand3, Prem Kumar4, Ashish Kumar Jha5, Ramesh Kumar6. 1. Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna, Bihar, India. drrajeevnp@gmail.com. 2. Department of Gastroenterology, Patna Medical College and Hospital, Patna, Bihar, India. 3. Department of G.I. Surgery, All India Institute of Medical Sciences, Patna, Bihar, India. 4. Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna, Bihar, India. 5. Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. 6. Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India.
Abstract
OBJECTIVE: To determine the efficacy and safety ultrasound-guided percutaneous catheter drainage (US-PCD) in management of various types of ruptured amebic liver abscess including free rupture (FR) with diffuse intraperitoneal fluid collections (DIFC). METHODS: This study analyzed 117 patients with ruptured ALA who underwent US-PCD. The indication for US-PCD was failure to respond to conservative treatment and/or percutaneous needle aspiration. RESULTS: Majority of patients were locally fermented alcohol abusers (95%), and malnourished (75%). Ninety-eight patients had intraperitoneal rupture including 66 contained rupture (CR) with localized intraperitoneal fluid collection (LIFC) and 32 FR with DIFC. Pleuropulmonary complication was found in 19 patients including 13 pleural and 6 pulmonary. A total of 333 catheters were used to drain 202 abscess cavities and associated fluid collections. US-PCD was technically and clinically successful in all cases. Multiple sessions (median 2; range 2-5) of PCD required with upsizing the catheter (median 14 F; range 14-20 F) and placement of additional catheter in 26 (22%) patients. The patients with FR with DIFC required more number of catheters (p = 0.01) and had longer hospital stay (p = 0.01). No major procedure related complication was observed. Six patients developed secondary bacterial infection; two of them presented with cavito-cutaneous fistula at catheter insertion site, and one with cholangitis due to biliary stricture formation necessitating subsequent endoscopic treatment. Post-procedural death occurred from sepsis in a patient with FR. CONCLUSION: US-PCD is a safe and effective mode of treatment for ruptured ALA including FR with DIFCs. We recommend PCD as a first-line therapy for ruptured ALA.
OBJECTIVE: To determine the efficacy and safety ultrasound-guided percutaneous catheter drainage (US-PCD) in management of various types of ruptured amebic liver abscess including free rupture (FR) with diffuse intraperitoneal fluid collections (DIFC). METHODS: This study analyzed 117 patients with ruptured ALA who underwent US-PCD. The indication for US-PCD was failure to respond to conservative treatment and/or percutaneous needle aspiration. RESULTS: Majority of patients were locally fermented alcohol abusers (95%), and malnourished (75%). Ninety-eight patients had intraperitoneal rupture including 66 contained rupture (CR) with localized intraperitoneal fluid collection (LIFC) and 32 FR with DIFC. Pleuropulmonary complication was found in 19 patients including 13 pleural and 6 pulmonary. A total of 333 catheters were used to drain 202 abscess cavities and associated fluid collections. US-PCD was technically and clinically successful in all cases. Multiple sessions (median 2; range 2-5) of PCD required with upsizing the catheter (median 14 F; range 14-20 F) and placement of additional catheter in 26 (22%) patients. The patients with FR with DIFC required more number of catheters (p = 0.01) and had longer hospital stay (p = 0.01). No major procedure related complication was observed. Six patients developed secondary bacterial infection; two of them presented with cavito-cutaneous fistula at catheter insertion site, and one with cholangitis due to biliary stricture formation necessitating subsequent endoscopic treatment. Post-procedural death occurred from sepsis in a patient with FR. CONCLUSION: US-PCD is a safe and effective mode of treatment for ruptured ALA including FR with DIFCs. We recommend PCD as a first-line therapy for ruptured ALA.