Medication, puncture, surgery? How should liver abscess be treated?

Author: Chen Jian, chief physician of Beijing Hospital

Reviewer: Yao Shukun, Chief Physician, China-Japan Friendship Hospital

Liver abscess is a serious infectious disease.

It can lead to abnormal liver function and an increase of more than three times in transaminase. It can also cause sepsis, which is now called sepsis or systemic infection, which is life-threatening. It can also be complicated by problems such as empyema and abdominal abscess, which seriously endanger our health.

Therefore, the treatment of liver abscess is very important. Generally speaking, the earlier the treatment, the better the effect.

1. Can liver abscess be cured by taking medicine alone?

Now, the understanding of liver abscess can be divided into several stages. If it is recognized and diagnosed early, early liver abscess can be completely relieved through conservative treatment and will disappear in about one to two weeks.

For example, early, sufficient and combined use of antibiotics, because most liver abscesses are caused by bacterial infections, early combined use of antibiotics can achieve good therapeutic effects.

In addition to antibiotics, supportive treatment is also required, because liver abscess can cause systemic inflammatory response syndrome, high fever, etc., which may affect the patient's eating, sweating and large amounts of fluid loss, etc., so nutritional support and infusion therapy need to be strengthened, otherwise the patient's nutrition will not be enough.

There are other treatments, including dietary conditioning, which is also an important part of treatment. For this infectious disease, in principle, you should supplement your diet with enough protein and sugar, eat less greasy or "heaty" food, and try not to eat spicy food.

Sometimes, it can be combined with traditional Chinese medicine treatment, including the use of traditional Chinese medicine for clearing away heat, removing fire and dispersing nodules, so that the treatment effect will be better.

2. Under what circumstances does liver abscess require puncture and drainage?

In the early stage of liver abscess, the abscess has not yet formed, matured or liquefied, and puncture drainage should not be used to avoid increasing trauma.

When imaging (such as CT, B-ultrasound) finds liver abscess, the abscess has already formed. For abscesses smaller than 5 cm, direct puncture can be performed to aspirate the pus. For mature liver abscesses larger than 5 cm, in addition to puncture, a catheter may need to be left in place, that is, the catheter is left in the abscess cavity for continuous drainage for several days or even weeks. For patients who receive timely treatment, the drainage volume will generally decrease after about three to five days, the abscess cavity will close, and the drainage tube can be removed.

Figure 1 Original copyright image, no permission to reprint

This is a minimally invasive surgical procedure that partially replaces traditional open surgical drainage.

The puncture and drainage of liver abscess has been performed under the guidance of X-ray or CT, with a semi-blind puncture method, and a semi-blind puncture method that determines and demarcates the location through B-ultrasound examination. It is still being used in local hospitals due to conditions and technical limitations. At present, large general hospitals have transitioned to using real-time B-ultrasound guidance, which means real-time monitoring to see how the puncture needle enters the abscess, which is more accurate. We call it puncture and drainage of liver abscess under real-time ultrasound guidance.

Most liver abscesses now require puncture and drainage, and most require indwelling catheters for drainage. For example, the commonly used pigtail catheter, also known as the double J tube, can be properly fixed in the liver abscess and is not easy to come out. Because the liver moves up and down with breathing, the catheter must be properly fixed when it is placed. Otherwise, it will soon move up and down with breathing, causing the catheter indwelling in the abscess cavity to come out and lose its drainage effect. When the abscess collapses and there is no pus inside, the catheter can be withdrawn.

3. What kind of liver abscess requires surgical removal?

For abscesses that repeatedly refuse to heal, a thicker abscess wall has formed, like a turtle shell. The shell is very thick, very hard, and does not collapse. Even if the pus inside is drawn out, it will not collapse and cannot close on its own. Generally, surgical removal is required, otherwise infection, pus accumulation, and even malignant transformation will occur repeatedly.

Figure 2 Original copyright image, no permission to reprint

There are many methods of surgical resection, including laparoscopic resection and open resection. Currently, laparoscopic resection with less surgical trauma is preferred because it is a benign disease and the less trauma, the better.

Whether it is a liver abscess that can be relieved by conservative treatment or a liver abscess that is chronic and requires surgical resection, it can be cured in most cases, but the prerequisite is to recognize it, pay attention to it, and treat it formally.

In the clinic, we have encountered such cases where the patient underestimated the infection and thought it was a common infection. After taking antibiotics for a week, the patient stopped taking the medicine when he thought the temperature had dropped. The patient also did not monitor the healing of the abscess. Three to five days after discharge, the patient's temperature rose again. This was because the bacteria inside had not been completely eliminated. In this case, it would be relatively difficult to treat the patient again. Therefore, in general, the application time and course of antibiotics must be sufficient to avoid the recurrence of liver abscesses.