Clinical application of ultrasound-guided surgical puncture and drainage in early treatment of pyogenic liver abscess

Abstract

Background: Pyogenic liver abscess (PLA) is a prevalent liver infection with gradual onset and severe symptoms, including fever, abdominal pain, jaundice, and vomiting. Complications like sepsis or toxic shock can also occur.

Aim: To investigate the clinical value of early ultrasound-guided percutaneous drainage (PCD) in PLA patients, specifically those with non-liquefied abscesses, and evaluate the feasibility of early intervention.

Methods: This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023. All patients underwent ultrasound-guided PCD. Based on the liquefaction status of the abscess, patients were divided into two groups: Liquefied group and non-liquefied group. Clinical outcomes, including puncture success rate, puncture duration, length of hospital stay, time to fever resolution, abscess shrinkage rate, and complication rates, were compared between the two groups.

Results: The puncture success rate for all patients was 99.3%, with a postoperative complication rate of 5.59%, and no intraoperative deaths occurred. Compared to the liquefied group, the non-liquefied group had significantly shorter hospital stays (3.9 ± 1.8 days vs 5.1 ± 2.7 days), faster fever resolution (2.4 ± 1.1 days vs 4.9 ± 2.2 days), and quicker abscess shrinkage (> 50%) (4.7 ± 1.5 days vs 8.6 ± 3.3 days) (P < 0.05). There were no significant differences in puncture success rates or complication rates between the two groups.

Conclusion: Early ultrasound-guided PCD can be safely and effectively performed in PLA, even when the abscess is not fully liquefied or is non-liquefied, supporting the clinical feasibility of early intervention.

Keywords: Clinical application; Early intervention; Percutaneous drainage; Pyogenic liver abscess; Ultrasonic guidance.

Figure 1

Imaging of abscesses before and after drainage. A: An abscess in segment VI of the liver (6.1 cm × 2.9 cm) with no obvious liquefaction observed; B: Successful puncture and catheter placement in the abscess; C: An abscess in segment V of the liver (6.0 cm × 4.7 cm) with no obvious liquefaction; D: One week after catheter insertion, the size of the abscess was reduced to 1.8 cm × 1.2 cm, and the abscess was removed and drained.