In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with
liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or
catheter drainage (n = 25) along with appropriate antimicrobial
therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the
abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given
catheter drainage (however, these patients were not included in the
catheter drainage group). For
catheter drainage, 8- to 12-French
catheters were introduced into the
abscess cavity using the Seldinger technique. In patients with multiple
abscesses (seven in aspiration group and five in
catheter group), all the
abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of
hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of
abscesses was achieved.
RESULTS: Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations,
catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean
hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the
abscess cavity was significantly (p < .05) greater in the aspiration group than in the
catheter group (11 days versus 5 days), the average time taken for total resolution of
abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks.
CONCLUSION: Our results show that percutaneous
catheter drainage is more effective than needle aspiration in the treatment of
liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.