This document discusses the treatment of intra-abdominal abscesses, specifically liver abscesses. It outlines that needle aspiration or catheter drainage is appropriate for liver abscesses under 5cm, while larger abscesses require catheter drainage or surgery. Needle aspiration is less invasive than catheter drainage but is only suitable for certain patients. Surgical drainage involves either an open transperitoneal or extraperitoneal approach. Complications of treatment can include sepsis, pleural effusions, or abscess rupture. The document also discusses amebic liver abscesses and notes that drainage may be needed as an adjunct to drug therapy if no response is seen within 5-7 days or for large abscesses.

1. INTRABDOMINAL ABSCESS
DR. RAHUL MRIGPURI
ASSISTANT PROFESSOR
GENERAL SURGERY

2. LIVER ABCESS- DRAINAGE
• <5cm, single abscess- needle aspiration or catheter
• >5cm- catheter
• Surgery
• Amoebic liver abscess: drainage not usually required
•Exceptions:
•Impending rupture
•Failure of conservative management
•Imminent need to exclude other diagnosis

3. Needle Aspiration of liver abscess

4. Percutaneous Catheter
Drainage

6. NEEDLE ASPIRATION AND PERCUTANEOUS
CATHETER DRAINAGE
• Needle aspiration is less invasive, less expensive, and
avoids all of the complications associated with catheter
care.
• Patients in whom percutaneous drainage is not
appropriate include those patients with
(1) multiple large abscesses;
(2)a known intra-abdominal source that requires surgery;
(3) an abscess of unknown etiology;
(4) ascites

7. SURGICAL DRAINAGE
• Abscesses were drained extraperitoneally via a 12th-rib resection
to
avoid contamination of the peritoneal cavity.
• With the advent of systemic antibiotics, transperitoneal
surgical exploration also was considered a safe surgical
approach.
• The transperitoneal approach has the advantages of the ability to:
(1)Treat the inciting pathology in the remainder of the
abdomen/pelvis;
(2)Gain access and exposure of the entire liver for evaluation
and treatment; and
(3)Access the biliary tree for cholangiography and bile duct
exploration.

8. Extraperitoneal drainage via a 12th-rib resection

9. Open Surgical drainage

10. laparoscopic drainage

11. COMPLICATIONS
 Generalized sepsis
 Pleural effusions
 Empyema
 Pneumonia.
 Abscesses may also rupture intraperitoneally, which is frequently
fatal. Usually, however, the abscess does not rupture, but develops
a controlled leak resulting in a perihepatic abscess.
Pyogenic abscesses also can cause hemobilia and hepatic vein
thrombosis

12. Amebic liver abscess

13. THERAPEUTIC ASPIRATION
• Therapeutic aspiration may occasionally be required as an
adjunct to antiparasitic treatment. Drainage should be
considered in patients that have no clinical response to drug
therapy within 5–7 days or those with a high risk of abscess
rupture defined as having a cavity >5 cm in diameter or by the
presence of lesions in the left lobe.

14. PERCUTANEOUS DRAINAGE
• Image-guided percutaneous treatment (aspiration or catheter
drainage) has replaced surgical intervention as the procedure of
choice for decreasing the size of an abscess.
• Percutaneous drainage remains most useful for treating
pulmonary, peritoneal, and pericardial complications. The high
viscosity of amebic abscess fluid, however, requires a large
diameter catheter for adequate drainage, and this may cause
more discomfort for the patient.
• Secondary infections related to the indwelling catheter are
always a risk of this intervention.

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