Percutaneous Management of Pyogenic Hepatic Abscesses

Twelve patients (9 men, 3 women) with a mean age of 65 (54-78) years, with pyogenic hepatic abscesses were managed by percutaneous drainage between 1979 and 1987. Biliary origin was most common (4 patients), followed by hepatic abscesses as a late postoperative complication (seen in 3 patients) and hepatic abscesses occurring in association with acute appendicitis (2 patients). The origin was unknown in 3 patients. Diagnosis was reached by computed tomography or ultrasonography with a diagnostic delay of in mean 11 days. Seventeen abscesses were found among the 12 patients. The median abscess size (maximal diameter) was 7 (1-12) cm. Nine patients were treated with percutaneous drainage with an indwelling catheter within the abscess cavity for up to 3 weeks, while 3 patients were managed with percutaneous puncture and aspiration alone. The most commonly isolated organism from the drained hepatic abscess was E. coli. The course following percutaneous treatment was uneventful, without mortality and recurrence of the hepatic abscess during follow-up. One patient required surgical drainage of an additional hepatic abscess. Percutaneous drainage of hepatic abscesses, independent of origin, thus seems as a safe and reliable method, which should be considered as the treatment of choice if facilities and knowledge of percutaneous management are provided

Detection of hepatic metastases in colorectal cancer : A prospective study of laboratory and imaging methods

Objective: To assess and compare the accuracy of imaging methods (ultrasonography (US), computed tomography (CT), angiography, arterially enhanced CT with computed tomographic arterial portography (CTA)), biochemical analyses, and surgical assessment during the operation, in detecting the presence or absence of hepatic metastases in patients with colorectal cancer. Design: Open study. Setting: University of Lund, Sweden. Subjects: 71 consecutive patients without clinical evidence of liver metastases at the time of the operation for removal of the primary tumour. Interventions: Regular biochemical tests for five to seven years, and CT and US one year after operation in all patients without confirmed metastases. Main outcome measures: Presence or absence of hepatic metastases. Results: Accuracy of surgical assessment, angiography, US, CT and CTA was 90, 77, 80, 82 and 83%, respectively, and corresponding predictive values of a negative test were 87, 75, 77, 80 and 84%. Measurement of bilirubin concentration and hepatic enzyme activities were not helpful, and that of carcinoembryonic antigen had an accuracy of only 70%. Accuracy and predictive values were not improved by combining tests. Conclusion: The accuracy of US, CT or CTA was not good enough to merrit routine use before operations for colorectal cancer. They are potentially valuable for monitoring progress at follow up, but this remains to be confirmed

Relationship between intensity of Opisthorchis viverrini infection and hepatobiliary disease detected by ultrasonography

Twenty-four locality-, age- and sex-matched groups of village residents with no light, moderate and heavy Opisthorchis viverrini infection were examined by ultrasonography. Highly significant differences were observed between the groups in the relative size of the left lobe of the liver and the fasting and post-meal size of the gall-bladder. In addition, indistinct gall-bladder wall, the presence of gall-bladder sludge and strongly enhanced portal vein radicle echoes were most frequently observed in the heavily infected group. Two suspected cases of cholangiocarcinoma were identified from the heavy group. The results highlight the importance of intensity of infection on the frequency and severity of fluke-associated hepatobiliary disease