Published online Jan 18, 2017. doi: 10.4254/wjh.v9.i2.114
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.
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.