A diabetic 38 years-old man has presented chills and fever with abdominal pain. Ct has showed a giant multiloculated liver abscess in central portion of the liver. He only presents renal insuficiency due sepsis, hemodialysis was done .Broad spectrum antibiotics was introduced without success. Drainage of multiple lesions is impossible. See that neither portal vein nor hepatic artery may be visualized . I am thinking in performing an open deroofing.
The decision needs to balance between surgeons' expertise, patient's clinical condition and expectation, as well as the back up plan for it.
If surgeon is experienced, and patient does not mind a follow-up re-operation from primary failure, I would go for laparoscopic approach first to remove the main bulk of the abscess, and then try percutaneous drainage later with systemic antibiotics.
However, if the aim is to control the sepsis, and hepatectomy expert is available, open approach will be more definitive
Finally, we have decided to perform an open abscess deroofing with success.
It seems than open surgery is the best option in order to complete the drainage of this difficult absceso
I think you performed a good job .In cases of liver abscess due to unilateral intrahepatic lithiasis (or Caroli disease) liver resection is the best treatment I have done few cases with very good results
I have performed liver resection for an hidiopatic multiloculated liver abscess. Sometimes resection is the only definitive treatment option in case of septic state refractary to systemic antbiitic therapy.
We have puplished this case many years ago https://pubmed.ncbi.nlm.nih.gov/16538117/?from_term=Sommariva+abscess&from_pos=1
We have published one series of hepatic resection for pyogenic abscess of the liver.
A partial surgical resection the more economical as possible is a good choice for resolving these cases
Our publication doi: 10.1590/0102-672020180001e1394. Hepatic resection for pyogenic abscess of the liver: Exception Approach?
We finally performed a left hepatectomy, because deroofing failed.
open deroofing is good approach . why did the deroofing failed ?? Sergio Renato Pais-Costa
A partial open hepatectomy would be the best option to resolve defitinevely this problem
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