Amoebic liver abscess surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Surgery is not the mainstay of treatment. Percutaneous needle aspiration and surgical open drainage are the surgical methods used to treat amoebic liver abscess.

Surgery

Surgery is not the mainstay of treatment. It is rarely required.

Percutaneous needle aspiration

• Indications for the drainage of amoebic liver abscess include:

• Absence of clinical response
• Worsening pain, tenderness, and jaundice
• Abscess with high risk of peritoneal or pericardial rupture (>10cm located in left liver lobe)
• Differentiate pyogenic from amoebic liver abscess
• Deterioration while in medical therapy
• Initial negative serology
• Non compliance for medical therapy
• Pregnancy

• Percutaneous needle aspiration is mostly recommended for large abscesses.
• This method is indicated when the abscess is not getting aspirated with needle or failure of ultrasound guided aspiration

Surgical open drainage

Surgical open drainage is rarely required and Indicated in the following conditions:

• Clinical deterioration despite attempted needle aspiration
• Complicated amoebic liver abscess (like ruptured abscess in peritoneal cavity with features of peritonitis, ruptured abscess in the pleural cavity/pericardial cavity/adjacent viscera)
• Large abscess with a poor yield on needle aspiration or percutaneous drainage