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

Core Tip: This study demonstrated that early ultrasound-guided percutaneous drainage (PCD) is safe and effective for pyogenic liver abscess (PLA), even in non-liquefied abscesses. By analyzing 143 PLA patients, we found that non-liquefied cases treated with early PCD had shorter hospital stays (3.9 vs 5.1 days), faster fever resolution (2.4 vs 4.9 days), and quicker abscess shrinkage compared to liquefied abscesses, with no increase in complications. These results challenge the traditional requirement for abscess liquefaction prior to intervention, advocating for early PCD to accelerate recovery and reduce healthcare burdens. This approach redefines clinical strategies for PLA management.