Treatment of hepatic and juxta-hepatic abscesses by puncture-drainage

The aim of this study was to show the result obtained by ultrasound-- or CT--guided puncture, possibly associated with transcutaneous drainage, for the treatment of hepatic and perihepatic abscesses. Preoperative imaging guides this treatment. It may reveal cavities as small as 1.5 cm in diameter. This nonsurgical treatment is based on single or multiple punctures, possibly followed by a long percutaneous drainage. The ideal indication is isolate liver abscesses located near the surface, as well as all juxtahepatic suppurative collections. Our experience is based on 73 patients, 32 of them presenting with an intrahepatic abscesses and 41 with a subphrenic or juxtahepatic abscess. For intrahepatic abscesses, healing was obtained with the surgical treatment in 75.3% of all cases: with a single puncture in 5 cases, two or more punctures in 4, and transcutaneous drainage in 11. Out of the 34 cases of perihepatic abscesses that underwent nonsurgical treatment, surgery was avoided in 25 cases, ie. 73.5% of all. Four of them were treated with a single puncture, 3 with repeated puncture, and 18 with transcutaneous drainage. The success of this procedure depends both on the indication and, most importantly, on the accurate application of the procedure.