Definitive treatment of a large pyogenic liver abscess with CT guidance

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Standard treatment of intraabdominal abscesses consists of drainage and antibiotic therapy.1–3 Previously, open surgical drainage was essential, but recently several authors have treated abscesses by closed aspiration and antibiotics. Novy et al4 reported two cases treated by closed aspiration with catheter placement for irrigation. The purpose of the catheters was not for sustained open drainage but for irrigation. We previously performed and reported closed needle aspiration of abscesses guided by CT scan,5 We are reporting a case of a solitary hepatic abscess treated by an end-hole No. 14 French Foley catheter placed percutaneously by means of a trocar guided by CT scans.

Case report

A 68-year-old white man with diabetes had a herniorrhaphy performed in another institution and did well until the 10th postoperative day. Then he became hypotensive and acute renal failure developed, at which time he was transferred to the Cleveland Clinic.

On admission, the patient was noted to have an open draining wound in the right inguinal area. Four days later, pulmonary edema, hypotension, and tachycardia developed. Because the patient had had a vena caval plication 6 years previously (for pulmonary emboli) a vena cavagram was done to rule out renal vein thrombosis. Caval thrombosis above the level of plication extended to T-12 and thrombi occluded both renal veins. Several days later, the patient became febrile (temperature, 104 F), hypotensive, and confused. A preliminary diagnosis of septic shock was made. Intravenous fluids and antibiotics were started. A gallium scan showed increased uptake over the liver (Fig.. . .



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