Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 18, 2017; 9(2): 114-118
Published online Jan 18, 2017. doi: 10.4254/wjh.v9.i2.114
Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess: Is it worth it?
Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina
Aylhin J Lopez-Marcano, Jose M Ramia, Vladimir Arteaga, Roberto De la Plaza, Jhonny D Gonzales, Anibal Medina, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
Author contributions: Lopez-Marcano AJ designed research; Ramia JM performed research; Lopez-Marcano AJ, Arteaga V, Gonzales JD and Medina A analyzed data; Lopez-Marcano AJ, Ramia JM and De la Plaza R wrote the manuscript.
Institutional review board statement: The protocol was approved by the Institutional Review Board (IRB) of the Hospital Universitario de Guadalajara.
Informed consent statement: I promise that all involved persons gave their informed consent prior to study inclusion.
Conflict-of-interest statement: None of authors have any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jose M Ramia, Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery, Hospital Universitario de Guadalajara, c/Donantes de Sangre, s/n, 19002 Guadalajara, Spain. jose_ramia@hotmail.com
Telephone: +34-616-292056
Received: June 2, 2016
Peer-review started: June 6, 2016
First decision: July 5, 2016
Revised: October 24, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: January 18, 2017

To delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity.


Using this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm.


All patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded.


LHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.

Keywords: Hydatidosis, Review, Surgery, Abscess, Liver

Core tip: Liver hydatid abscess (LHA) management is not standardized. The traditional treatment is emergency surgery but the results are usually suboptimal because the patients are in poor medical condition. The initial treatment of LHA in septic patients with percutaneous drainage in combination with antibiotic therapy and supportive measures allows control of the infection and improves the patient’s general condition. This enables the physician to treat the patient in greater safety and also reduces complications.