ELECTIVE ONE-STAGE ABDOMINAL OPERATIONS AFTER PERCUTANEOUS CATHETER DRAINAGE OF PYOGENIC LIVER-ABSCESS

During the past 10 years, 15 patients have had percutaneous catheter d rainage (PCD) of pyogenic liver abscesses (PLA) at a major teaching ho spital. Five PLA were related to biliary tract disease, two were secon dary to colonic diverticulitis, two developed after abdominal surgery, and the remaining were associated with hepatic trauma, gastric ulcer, Crohn's ileitis, and colon cancer. Two abscesses were cryptogenic. Me an diameter of PLA was 8 cm and ranged from 2-14 cm. Three patients ha d multiple PLA. All patients were initially treated by PCD without maj or complications. However, one patient required a second PCD after dev eloping a recurrent abscess. Fever and leukocytosis defervesced at a m ean 3.6 days and 7 days, respectively, after PCD. Seven of the 15 pati ents subsequently had one-stage elective abdominal operations for trea tment of diseases underlying PLA including two cholecystectomies, two colon resections, one gastrectomy, one ileostomy closure, and one lapa rotomy for unresectable gall bladder cancer. There were no postoperati ve complications. These results demonstrate that PLA are best treated by using PCD as primary treatment with surgical drainage reserved for patients who do not respond clinically to PCD. The need for operative treatment in diseases underlying PLA should not deter use of PCD as pr imary treatment.