Irrigation of liver abscess: Proposal of a novel method and possible indications

We present here two suggestive cases in considering the advantages and disa dvantages of irrigation of pyogenic liver abscess: one patient developed an intrahepatic hematoma as an unusual sequela, while the other was successfu lly treated by abscess irrigation, overcoming failure of percutaneous cathe ter drainage and the patient's seriously ill condition. Based on these case s, we propose a novel method of liver abscess irrigation via percutaneous d rainage tubes with the following three characteristics: 1) use of a drip in fusion apparatus for irrigant instillation and drainage in order to avoid e levation of pressure in the abscess, a source of potential life-threatening sequelae, 2) addition of contrast medium to irrigant, and 3) employment of computed tomography in dynamic equilibrium of irrigant in order to evaluat e the efficacy of current irrigation. Of interest was the parenchymal enhan cement around the irrigated liver abscess revealed by computed tomography w ith this method, which suggested that dissemination of abscess contents may be inevitable with irrigation. Although the indications for liver abscess irrigation must be considered carefully given the critical sequelae potenti ally associated with it, the method we present can be used as a second-line trial exclusively for Liver abscesses refractory to first-line treatment w ith percutaneous catheter drainage or needle aspiration, since it can be us ed not only as a therapeutic procedure with mechanical washing or dilution of abscess contents but also as a diagnostic aid enabling more effective su bsequent treatment by defining the areas in which drainage and irrigation i s not effective.