NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Figure 7-33: CT scan of a solitary hepatic abscess.

location from a perforated abdominal viscus into the portal vein or arterial embolization of bacteria via the hepatic artery due to IV drug abuse is also likely in this case. Abscesses can be small and multiple or large and singular. For proper treatment with antibiotics, it is necessary to obtain a sample culture. Larger abscesses are treated by percutaneous drainage. It is appropriate to leave the catheter in place for 2–3 weeks and give IV antibiotics simultaneously. If other biliary pathology ex- ists, the drained abscess fails to improve, or surgery is necessary for any other reason, open drainage is warranted. The preferred treatment for multiple, small pyogenic abscesses is broad-spectrum IV antibiotics for 4–6 weeks. Generally, initial therapy of large, single pyogenic liver abscesses is percutaneous drainage via radio- logic guidance. Q: If the patient has a large, single liver abscess and serologies positive for E. histolytica , how does this alter the proposed treatment plan? A: The treatment for amebic abscesses is metronidazole alone; bacterial superinfection may occur with aspiration of uncomplicated amebic abscesses.

CUT TO TEXTBOOK For more information, see NMS Surgery , 7th ed, Chapters 10 and 11. SAMPLE