PERCUTANEOUS DRAINAGE OF HEPATIC-ABSCESSES - THERAPY DOES NOT DIFFER FOR THOSE WITH IDENTIFIABLE BILIARY FISTULA

Background/Aims: Surgical drainage of pyogenic and amoebic hepatic abs cesses has been an accepted therapy for decades. Modern imaging modali ties have changed both the diagnostic and therapeutic management of ma ny hepatic lesions, particularly abscesses. Specifically, percutaneous aspiration and drainage with either ultrasound or computed tomography guidance has been reported as an alternative treatment for hepatic ab scesses in recent years. Little is known about aspiration of hepatic a bscesses that communicate with the biliary tree. Material and Methods: Fifteen patients with hepatic abscesses treated by percutaneous aspir ation and drainage are herein reported. Six had a demonstrable fistulo us communication between the abscess and the biliary tree. Results: Du ring a four year period of follow-up, only two of these 15 patients ex perienced a recurrence. Neither had a biliary fistula complicating the ir abscess initially. Conclusions: Based upon this experience, it is s uggested that percutaneous aspiration and drainage should be the initi al treatment of choice of both pyogenic and amoebic liver abscesses ev en when large. Abscesses with demonstratable biliary fistulas have a l arger mean volume than do those without fistulous involvement. The fin ding of a communication between the abscess and the biliary tree shoul d not change this treatment approach.