Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial Efficacy of aspiration in amebic liver abscess. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. Management of large amoebic liver abscess--a comparative study of needle aspiration and catheter drainage. Needle aspiration in large amoebic liver abscess. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Amoebic liver abscess: the effect of aspiration on the resolution or healing time. Comparative study of tinidazole versus metronidazole in treatment of amebic liver abscess: A randomized control trial Amoebic liver abscess: ultrasonographic characteristics and results of different therapeutic approaches. Ultrasound-guided needle aspiration of amoebic liver abscess. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. Needle aspiration of amoebic liver abscess. Indications for aspiration of amoebic liver abscess. Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. Long term follow-up of amebic liver abscess: clinical and ultrasound patterns of resolution. Drainage is unnecessary after elective liver resection.
Summary Amoebic liver abscess develops in less than 1 % of patients with amoebaisis and metronidazole is the drug of choice for the treatment of amebic liver abscess . Abscesses of less than 5 cm can be treated with metronidazole alone . However , abscesses of more than 10 cm must undergo ultrasound guided percutaneous needle aspiration along with metronidazole . The role of percutaneous needle aspiration in abscesses of 5 to 10 cm is not clear . Fifty-seven patients with a solitary , right lobe , uncomplicated amoebic liverabscess of 5–10 cm were r and omized to receive either metronidazole alone ( control group ; n = 29 ) or ultrasound guided percutaneous needle aspiration along with metronidazole ( intervention group ; n = 28 ) . Although the resolution of pain and fever occurred earlier in the intervention group ( 27 h and 17 h , respectively ) than the control group ( 48 h and 30 h , respectively ) , the difference was not statistically significant ( P = 0.16 and 0.48 , respectively ) . There were no deaths during the study period and treatment failure , complications ( rupture of abscess ) , days to normalization of leukocytosis and duration of hospitalization were similar in both groups . Ultrasound guided percutaneous needle aspiration along with metronidazole was no better than metronidazole alone in the management of uncomplicated , solitary , right lobe amoebic liver abscess of 5 to 10 cm BACKGROUND Amebic liver abscess ( ALA ) is a common and serious problem in our country . There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy , over pharmacotherapy alone for amebic liver abscess . MATERIAL AND METHODS This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small ( up to 5 cm ) and large ( 5 cm to 10 cm ) size ALA . This is one of the largest single center , prospect i ve , r and omized studies comparing the efficacy of aspiration in ALA . RESULTS ( i ) Mean body temperature , liver tenderness , total leukocyte count ( TLC ) , serum alanine aminotransferase ( ALT ) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess ( 5 cm to 10 cm ) . ( ii ) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15 , and 1 month & 3 months in large abscess ( 5 cm to 10 cm ) . CONCLUSIONS ( i ) Needle aspiration along with metronidazole hastens clinical improvement especially in large ( 5 cm up to 10 cm ) cavities in patients with ALA . ( ii ) Aspiration is safe and no major complications occurred . ( iii ) Hence , combination therapy should be the first choice especially in large ALA ( 5 cm to 10 cm ) OBJECTIVE The purpose of this study was to determine the effectiveness of percutaneous catheter drainage ( PCD ) and to compare PCD with percutaneous needle aspiration in the management of liver abscess . SUBJECTS AND METHODS Sixty patients with pyogenic liver abscess were r and omly assigned to two groups in a prospect i ve study . Antibiotics were administered for 10 days , starting the day of the beginning of percutaneous treatment . One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration . Percutaneous needle aspiration was attempted a maximum of three times . Lack of response to the third aspiration was considered failure of treatment ; these patients were treated with PCD but were not included in the PCD group for analysis . Patient demographics , duration of hospital stay , treatment outcome , and complications were analyzed . RESULTS Percutaneous needle aspiration was successful in 20 ( 67 % ) of the 30 patients after one ( n = 12 ) , two ( n = 7 ) , or three ( n = 1 ) aspirations . PCD was curative in all 30 patients after one ( n = 24 ) or two ( n = 6 ) procedures . All abscesses 50 mm or less in longest diameter were successfully managed , 10 by percutaneous needle aspiration and 12 by PCD . None of patients in the percutaneous needle aspiration group with multiloculated abscesses ( n = 5 ) was successfully treated . Hospital stay did not differ significantly between the groups . There were no complications related to the procedure . CONCLUSION PCD is more effective than percutaneous needle aspiration in the management of liver abscess . Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller Objective To compare the effectiveness of percutaneous catheter drainage ( PCD ) and percutaneous needle aspiration ( PNA ) in the management of large ( > 10 cm diameter ) liver abscesses . Methods Seventy-two patients with liver abscess ( amebic 48 , pyogenic 24 ) were r and omly allocated to PCD or PNA ( 36 each ) , which were done within 24 hours of admission . Both groups received parenteral antibiotics for at least 10 days . PNA was repeated every third day if the cavity size had not declined to 50 % of the original for up to three times . Persistence of cavity or of clinical symptoms was considered failure of treatment . Duration to attain clinical relief , duration of hospital stay , complications , treatment failure , and deaths were recorded . Results PNA was successful in 31 of 36 ( 86 % ) patients ( one aspiration in 10 , two in 18 , and three in 3 patients ) , whereas PCD was successful in 35 ( 97 % ) patients ( p = ns ) . Duration to attain clinical relief ( 10.2 [ 2.0 ] vs. 8.1 [ 2.7 ] days ; p=0.02 ) and parenteral antibiotics needed ( 15.5 [ 1.1 ] vs. 10.9 [ 2.7 ] days ; p=0.04 ) were significantly lower in PCD group . Duration of hospital stay was similar in the two groups . One patient with PNA had a subcapsular hematoma and one with PCD had continuous bile leakage which stopped spontaneously . One patient in PCD group died . Conclusion PCD is a better treatment option than PNA for the management of large liver abscesses of size > 10 cm , in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed The performance of therapeutic aspiration in the treatment of amebic liver abscess , advocated and practice d in many centers , is controversial . Previously , this practice has been evaluated in retrospective analyses . To test the potential benefit of therapeutic aspiration , the authors undertook a prospect i ve r and omized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period . Sixteen patients were excluded from the trial . The remaining 41 patients were r and omly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration . All patients in the trial recovered . No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated : length of hospitalization and duration of time to becoming afebrile . Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level . These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess . Amebicidals alone were equally efficacious in treating the group studied OBJECTIVE This study was design ed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses . SUBJECTS AND METHODS In a r and omized study , 50 patients ( 38 males and 12 females ; age range , 2 - 72 years ; average age , 35 years ) with liver abscesses ( amebic , 20 ; pyogenic , 11 ; indeterminate , 19 ) underwent either percutaneous needle aspiration ( n = 25 ) or catheter drainage ( n = 25 ) along with appropriate antimicrobial therapy . In patients assigned to the needle aspiration group , an 18-gauge needle was used to aspirate the abscess cavity . Repeated aspiration was attempted only once in each patient not responding to the first aspiration ; nonresponse to the second aspiration was considered failure of treatment , and these patients were given catheter drainage ( however , these patients were not included in the catheter drainage group ) . For catheter drainage , 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique . In patients with multiple abscesses ( seven in aspiration group and five in catheter group ) , all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment . Patients were followed up to assess the outcome of the percutaneous treatment , length of hospital stay , and development of any complications .  Sonography was performed every third day during hospitalization . After discharge of the patient , periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved . RESULTS Although percutaneous needle aspiration was successful in only 15 ( 60 % ) of the 25 patients after one ( n = 11 ) or two ( n = 4 ) aspirations , catheter drainage was curative in all 25 patients ( 100 % ) ( p < .05 ) . Among the successfully treated patients , the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups . Although the average time needed for a 50 % reduction in the size of the abscess cavity was significantly ( p < .05 ) greater in the aspiration group than in the catheter group ( 11 days versus 5 days ) , the average time taken for total resolution of abscess was the same ( 15 weeks ) in both groups . No major complications were encountered . No relapse was documented on clinical and sonographic examination during follow-up , which ranged from 8 to 37 weeks . CONCLUSION Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses . Needle aspiration , if limited to two attempts , has a high failure rate Amoebiasis in endemic in the tropical countries with amoebic liver abscesses being a common complication . Different modalities of treatment of amoebic liver abscess are conservative ( medical management ) , percutaneous needle aspiration , percutaneous catheter drainage , surgical drainage and endoscopic drainage . This study was carried out to compare the efficacy , safety and outcome of needle aspiration comparing with percutaneous catheter drainage of large ( > or = 5 cm diameter ) amoebic liver abscesses . This was a prospect i ve study carried over a period of two years ( 2006 - 2008 ) at the general surgery department of Calcutta National Medical College and Hospital , Kolkata . A total of 45 patients were included in this study . All of them had amoebic liver abscess with diameter of abscess cavity > or = 5 cm . They were divided into two groups . Group A included 22 patients and they were treated with needle aspiration . Group B included 23 patients and they were treated by catheter drainage . Improvement in clinical features , liver function tests , ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment . The sex ratio and the age incidence in the two groups were similar . In about 80 % patients the right lobe was affected , in about 18 % the left lobe was affected and in rest the abscess involved both lobes . Needle aspiration was successful in 15 ( 68.2 % ) and catheter drainage was successful in 23 patients ( 100 % ) . The mean hospital stay of patients treated with needle aspiration was more than those treated with catheter drainage . The mean time in days taken for 50 % decrease in the size of abscess cavity was significantly greater in group treated with needle aspiration than in those treated with catheter drainage ( 9 days versus 4 days ) . It is concluded that percutaneous catheter drainage is more effective in management of large amoebic liver abscess than needle aspiration The role of percutaneous needle aspiration for therapy of uncomplicated , large amoebic liver abscess ( ALA ) is not defined . Twenty nine patients of ALA with a cavity larger than 5 cm were r and omised to two groups : ( i ) metronidazole 800 mg tid for 10 days combined with needle aspiration ( group A , n = 15 ) and ( ii ) metronidazole therapy alone ( group B , n = 14 ) . Clinical parameters , viz , fever , pain and abdominal tenderness were recorded daily and grade d 0 to 3 ( in order of increasing severity ) . A statistically significant benefit was demonstrated in group A for clinical parameters evaluated . Group A patients took less time to become afebrile from the grade 2 level as compared to group B ( 3.8 + /- 1.7 days and 5.6 + /- 2.2 days respectively ; p < 0.05 ) . Reduction in pain intensity and abdominal tenderness from grade 2 to 1 also occurred earlier in group A ( 0.7 + /- 0.7 days vs 2.9 + /- 0.9 days for pain , P < 0.001 and 1.7 + /- 0.8 days vs 2.9 + /- 1.2 days for abdominal tenderness , p < 0.001 ) . The mean duration of hospitalization was significantly shorter in group A as compared to group B ( 5.8 + /- 0.8 days vs 7.4 + /- 1.5 days , p < 0.001 ) . Improvement in haematological and biochemical variables was similar in both groups . We conclude that percutaneous therapeutic needle aspiration of uncomplicated , large ALA hastens clinical recovery Background The aim of the study was to evaluate the clinical presentation , and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses . Methods This is a prospect i ve r and omized comparative study of 60 patients , presented in outpatient and emergency department at the hospital , r and omized equally into two groups , percutaneous needle aspiration and pigtail catheter drainage .  The effectiveness of either treatment was measured in terms of duration of hospital stay , days to achieve clinical improvement , 50 % reduction in abscess cavity size and total/near total resolution of abscess cavity . Independent t-test was used to analyze these parameters . Results The success rate was significantly better in catheter drainage group ( P=0.006 ) . The patients in pigtail catheter drainage group showed earlier clinical improvement ( P=0.039 ) and 50 % decrease in abscess cavity volume ( P=0.000 ) as compared to those who underwent percutaneous needle aspiration . Conclusion Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses . Over a 5-year period , 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics ( ampicillin , cefuroxime , and metronidazole ) and r and omized into two percutaneous treatment groups : continuous catheter drainage ( with an 8F multi-sidehole pigtail catheter ) ; and intermittent needle aspiration ( 18 G disposable trocar needle ) . There was no statistically significant difference between the two groups regarding patient demographics , underlying coexisting disease , abscess size , abscess number , number of loculation of abscess , the presenting clinical symptoms such as fever , abdominal pain , and pretreatment liver function test . Although not statistically significant , the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group , and the change of antibiotics after the sensitivity test was more frequent with the needle group . The needle group was associated with a higher treatment success rate , a shorter duration of hospital stay , and a lower mortality rate , although this did not reach statistical significance . In conclusion , this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess , although further proof with a large-scale study is necessary . Due to the additional advantages of procedure simplicity , patient comfort , and reduced price , needle aspiration deserves to be considered as a first-line drainage approach Thirty-nine patients with amoebic liver abscess ( ALA ) , admitted to the Central Hospital of Hué ( Vietnam ) , were evaluated in a comparative , prospect i ve and r and omized study for the treatment of ALA . Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included . Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients . Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration . The clinical symptoms fever , pain in right upper abdomen and liver tenderness , and the laboratory parameters erythrocyte sedimentation rate , white blood cells , haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days . Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days ( P < 0.001 ) , whereas all the other parameters showed no differences between the two groups . This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe Recent sonographic monitoring of patients treated for amoebic liver abscess has shown the healing or resolution time varying between 10 and 300 days . The effect of percutaneous needle aspiration under or resolution time was studied in 36 patients . Nineteen patients had drugs and needle aspiration under ultrasound guide whilst the 17 patients had drugs -- metronidazole , diloxanide , and chloroquine -- alone . Both groups were monitored clinical ly and sonographically . Results showed that the abscess cavities of 18 out of 19 patients ( 94.7 % ) of the aspirated group and 10 of 17 patients ( 58.8 % ) of the non-aspirated group had resolved at the end of three weeks . The difference in response to treatment was significant ( P less than 0.02 ) more so for lesion size more than 6 cm ( P less than 0.01 ) . There was also a more rapid clinical response in the aspirated group than in the non-aspirated group , particularly for patients whose lesion size was more than 6 cm ( P less than 0.01 ) . In conclusion , percutaneous needle aspiration is safe , enhances clinical recovery , and accelerates resolution particularly in patients with large abscess cavities Background Metronidazole is a drug of choice for amebic liver abscess ( ALA ) , but has long course and significant side effects . Thus , drugs like tinidazole with a better tolerability record need evaluation . Methods We conducted a r and omized controlled trial at the Department of Gastroenterology , SMS Hospital , Jaipur , India . One hundred and fifty admitted patients were r and omized into two treatment groups , metronidazole ( group M , n = 75 ) and tinidazole ( group T , n = 75 ) . Patients were observed for clinical response , laboratory parameters , imaging , and side effects . Early clinical response ( ECR ) was defined as the absence of fever and abdominal pain within 72 h of treatment . Symptomatic clinical response ( SCR ) was defined as the absence of fever and abdominal pain irrespective of duration of treatment required . Follow up was done at 1 , 3 , and 6 months . Results ECR was 62.3 % in group T vs. 37.7 % in group M ( p = 0.02 ) . SCR was shorter in group T than group M ( 3.29 ± 1.61 days vs. 5.67 ± 2.93 , p ≤ 0.001 ) . Mean residual volume at the end of 1 month was lower in group T ( 130.7 ± 108.1 vs. 184.7 ± 143.3 mL , p = 0.01 ) and no significant difference was seen at 3 and 6 months  . Tinidazole was better tolerated with fewer side effects . Low socioeconomic status , baseline abscess volume > 500 mL , hypoalbuminemia , pleural effusion , and history of ethanol use were associated with a late clinical response on univariate analysis of which low socioeconomic status was the only associated factor . Conclusion Tinidazole , as compared to metronidazole , has early clinical response , shorter treatment course , favorable rate of recovery , and high tolerability ; thus , tinidazole can be preferred over metronidazole in ALA This prospect i ve study was carried out on 33 patients with clinical ly , serologically and ultrasonographically confirmed amoebic liver abscess . All patients were r and omly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage .  Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape , usually hypoechogenic content with specific dorsal sonic enhancement , and in the majority of cases , location near liver capsule . Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment . The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses This prospect i ve study was carried out on 200 patients with clinical ly , ultrasonographically and serologically confirmed amoebic liver abscess . The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone . Both the groups were monitored clinical ly and sonographically for up to 6 months after diagnosis . The initial response ( after 15 days ) was better in the aspirated group ( P < 0.05 ) but resolution of abscess after 6 months were similar . There was a more rapid clinical response in the aspirated group , particularly in those with larger ( > 6 cm ) abscesses and there were no complications . Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery , accelerates resolution , especially in large abscesses , and prevents complications OBJECTIVE Given the perceived technical dem and s of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess , initial percutaneous drainage has become an attractive option in this patient population . This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon . However , the medical burden on the patient and on the quality of patient outcomes has not been described in the literature . Therefore , we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospect i ve trial . METHODS After institutional review board approval , a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006 . Continuous variables are listed with st and ard deviation . RESULTS There were 52 patients with a mean age of 9.0 + /- 3.9 years and weight of 34.4 + /- 18.8 kg . The  mean duration of symptoms at presentation was 8.4 + /- 7.6 days . Percutaneous aspiration only was performed in 2 patients . The mean volume of fluid on initial aspiration/drain placement was 76.3 + /- 81.1 mL. The mean time to appendectomy was 61.9 + /- 25.2 days . The laparoscopic approach was used in 49 patients ( 94.2 % ) , of which one was converted to an open operation . The mean length of hospitalization after interval appendectomy was 1.4 + /- 1.4 days . A recurrent abscess developed in 17.3 % of the patients . Six patients ( 11.5 % ) required another drainage procedure . The mean total charge to the patients was $ 40,414.02 . There were 4 significant drain complications ( ileal perforation , colon perforation , bladder perforation , and buttock/thigh necrotizing abscess ) . The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy . CONCLUSIONS The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach . However , this management poses complication risks and uses considerable re sources . Therefore , this strategy should be compared with early operation in a prospect i ve trial OBJECTIVE --To determine the value of needle aspiration in uncomplicated amoebic liver abscess . DESIGN --R and omised case-control study with a minimum follow up of one year , comparing patients treated with drugs alone with those treated with additional needle aspiration . SETTING --Referral based gastroenterology clinic . PATIENTS --39 Consecutive patients with amoebic liver abscess in the right lobe , of whom 37 completed the study . INTERVENTION -- Metronidazole 2.4 g/day was given to all patients for 10 days . Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital . MAIN OUTCOME MEASURES --Abdominal pain , fever , anorexia , and hepatomegaly were measured . Erythrocyte sedimentation rate , serum aspartate , and alanine aminotransferase activities , and alkaline phosphatase activity were also measured . RESULTS -- Clinical improvement was similar in both groups of patients . Improvement in haematological and biochemical variables and rates of healing of cavities were also similar . CONCLUSIONS --Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess , and in uncomplicated cases routine aspiration is not required A two-part study was undertaken to determine whether aspiration of amoebic liver abscess ( ALA ) prevents complications .  Eighty patients studied prospect ively were r and omised into aspiration or non-aspiration groups and were treated with metronidazole . Common factors in patients with complicated diseases were determined to formulate and test indications for aspiration . Records of all patients with ALA admitted to King Edward VIII Hospital , Durban , between October 1983 and December 1984 were analysed to test the validity of the criteria derived from the first part of the study . The findings suggest that aspiration influences the course and outcome of ALA and that the criteria are valid although not necessarily complete Background The present study was design ed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess . Methods In a prospect i ve study , 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were r and omly assigned to two groups . The first group received treatment with ultrasound guided-percutaneous drainage and i.v . antibiotics ( ampicillin , cefuroxime , and metronidazole ) , and the other group received antibiotics only .  Patient ’s baseline characteristics , duration of hospital stay , and treatment outcome and complications were analyzed . Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 ( 95 % CI = 0.22–0.62 ; p < 0.05 ) . One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment . Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy . There was no statistically significant difference between the two groups regarding patient demographics , abscess size , and pretreatment clinical symptoms . Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter ( p < 0.001 ) in the drainage group , with a mean difference of 6.4 days ( 95 % CI = 5.0–7.9 ; p < 0.05 ) . Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis . The recurrence rate for these patients is relatively low , and very often interval appendectomy is not required . For patients with periappendiceal abscess ≥ 3 cm in diameter , antibiotic therapy alone is insufficient and the recurrence rate is high Objectives To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage ( PCD ) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments . Methods Eighty-one patients with severe acute pancreatitis ( SAP ) were admitted and divided into three groups : forty-nine cases in the conservative therapy group ; nineteen cases in the surgery group ; and thirteen cases in the PCD therapy group . Forty-five patients with a CT severity index ( CTSI ) ≤ 8.0 received conservative treatment . One patient with CTSI = 7.0 underwent surgery . Thirty-five patients with a CTSI > 8.0 were r and omly selected for surgery or PCD treatment . After r and omization , six patients ( four patients in the surgery group and two patients in the PCD group ) were dropped from the study . The total number of patients included in the surgery and PCD groups was sixteen and thirteen , respectively . Results Four patients ( 8.2 % ) in the conservative therapy group died , five patients ( 31.3 % ) in surgery group with a CTSI > 8.0 died , and all patients in the PCD group survived . The mortality rate was lower in the PCD group than in the surgery group ( P = 0.048 ) . The serum C-reactive protein ( CRP ) level recovered more quickly in patients in the PCD group compared to those in the surgery group ( P < 0.001 ) . Conclusions Patients with SAP and a CTSI ≤ 8.0 could be treated with conservative therapy , while patients with a CTSI > 8.0 should be treated with surgery or PCD therapy if the life-threatening complications of extensive fluid collection or necrosis are a factor . However , PCD therapy used in a timely manner for drainage may decrease mortality in patients with SAP , decrease inflammatory mediator release , and avoid incidence of severe sepsis or acute respiratory distress syndrome ( ARDS ) and emergency surgery INTRODUCTION Perforated appendicitis is a common condition in children , which , in a small number of patients , may be complicated by a well-formed abscess . Initial nonoperative management with percutaneous drainage/aspiration of the abscess followed by intravenous antibiotics usually allows for an uneventful interval appendectomy . Although this strategy has become well accepted , there are no published data comparing initial nonoperative management ( drainage/interval appendectomy ) to appendectomy upon presentation with an abscess . Therefore , we conducted a r and omized trial comparing these 2 management strategies . METHODS After internal review board approval ( # 06 11 - 164 ) , children who presented with a well-defined abdominal abscess by computed tomographic imaging were r and omized on admission to laparoscopic appendectomy or intravenous antibiotics with percutaneous drainage of the abscess  ( when possible ) , followed by interval laparoscopic appendectomy approximately 10 weeks later . This was a pilot study with a sample size of 40 , which was based on our recent volume of patients presenting with appendicitis and abscess . RESULTS On presentation , there were no differences between the 2 groups regarding age , weight , body mass index , sex distribution , temperature , leukocyte count , number of abscesses , or greatest 2-dimensional area of abscess in the axial view . Regarding outcomes , there were no differences in length of total hospitalization , recurrent abscess rates , or overall charges . There was a trend toward a longer operating time in patients undergoing initial appendectomy ( 61 minutes versus 42 minutes mean , P = .06 ) . CONCLUSIONS Although initial laparoscopic appendectomy trends toward a requiring longer operative time , there seems to be no advantages between these strategies in terms of total hospitalization , recurrent abscess rate , or total charges A prospect i ve study was undertaken to evaluate the clinical and sonographic patterns of resolution in amebic liver abscess ( ALA ) . There were 146 patients of ALA attending the gastroenterology clinic of a tertiary care centre of whom 25 died . Of the remaining 121 patients , 107 were followed up for 20.9 + /- 11.4 months . 14 ( 11.3 % ) patients were lost to follow up before complete disappearance of the cavity . Complete disappearance of the cavity was seen in 84 ( 78.5 % ) and a reduction in volume to 50 % at entry in 23 ( 21.5 % ) . Abdominal pain , fever and hepatomegaly were the predominant forms of clinical presentation . On ultrasound , there were 121 cavities in 107 patients . The most frequent type of lesion was solitary , ( 96 % ) round cavity ( 80.4 % ) in the right lobe of liver ( 85 % ) . Clinical and hematological parameters of resolution occurred rapidly ( 3.2 + /- 2.9 months ) . Sonographic resolution took much longer ( 9.6 + /- 6.8 % months ) in the 84 patients . The remaining 23 patients are on follow up . Three pattern of resolution were observed : Type I -- where complete disappearance of the cavity occurred within 3 months ( 29.8 % ) , Type II -- where a gradual reduction and disappearance of the cavity occurred ( 64.3 % ) and Type III -- where a rapid reduction till 25 % of original cavity size remained and then a delayed resolution occurred ( 5.9 % ) . There were no relapses in the patients on follow up . Factors that influenced healing time included the size of the abscess cavity at admission , hypoalbuminemia and anemia . The type of clinical presentation , nature of therapy , number or location of abscesses and time for clinical resolution did not influence the resolution time . None of the variables studied influenced the pattern of resolution . We conclude that rapid clinical resolution is common in patients with ALA . Sonographic resolution may be delayed and does not warrant additional or prolonged therapy PURPOSE A prospect i ve , r and omized trial was performed to determine if intra-abdominal drainage catheters are necessary after elective liver resection . PATIENTS AND METHODS Between April 1992 and April 1994 , 120 patients subjected to liver resection , stratified by extent of resection and by surgeon , were  r and omized to receive or not receive operative closed-suction drainage . Operative blood loss was not an exclusion criteria , and no patient who consented to the study was excluded . RESULTS Eighty-seven patients ( 73 % ) had resection of one hepatic lobe or more ( 27 lobectomies , 54 trisegmentectomies , and 6 bilobar atypical resections ) and 33 had less than a lobectomy ( 8 wedge resections or enucleations , 9 segmentectomies , and 16 bisegmentectomies ) . Eighty-four patients ( 70 % ) had metastatic cancer and 36 patients ( 30 % ) had primary liver pathology . There were no differences in outcome , including length of hospital stay ( no drain , 13.4 + /- 0.9 days ; drain , 13.1 + /- 0.8 days ; P = not significant [ NS ] ) , mortality ( no drain , 3.3 % ; drain , 3.3 % ) , complication rate ( no drain , 43 % ; drain , 48 % ; P = NS ) , or requirement for subsequent percutaneous drainage ( no drain , 18 % ; drain , 8 % ; P = NS ) . All infected collection s ( n = 3 ) occurred in operatively drained patients . Two other complications were directly related to the operatively placed drains . One patient developed a subcutaneous abscess at the drain site , and a second developed a subcutaneous drain tract tumor recurrence as the only current site of recurrence . CONCLUSION In the first 50 consecutive resections performed since the conclusion of this trial , only 4 patients ( 8 % ) have required subsequent percutaneous drainage . We conclude that abdominal drainage is unnecessary after elective liver resection
There was no significant difference in relation to the resolution of fever , abscess size , and hospital stay .
The beneficial effects of PA were seen with medium-to-large ( > 5 cm ) ALA and not with small ( < 5 cm ) ALA .
Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA .
Percutaneous catheter drainage is better for larger ALA .
The role of metronidazole alone , percutaneous aspiration ( PA ) , and percutaneous catheter drainage ( PCD ) in the treatment of uncomplicated amebic liver abscess ( ALA ) is still unclear .
This systematic review and meta- analysis evaluated the available evidence s with regard to treatment modalities in such patients .