Abdominal Radiology

, Volume 44, Issue 3, pp 877–885 | Cite as

Ultrasound-guided percutaneous catheter drainage of various types of ruptured amebic liver abscess: a report of 117 cases from a highly endemic zone of India

  • Rajeev Nayan PriyadarshiEmail author
  • Vijay Prakash
  • Utpal Anand
  • Prem Kumar
  • Ashish Kumar Jha
  • Ramesh Kumar



To determine the efficacy and safety ultrasound-guided percutaneous catheter drainage (US-PCD) in management of various types of ruptured amebic liver abscess including free rupture (FR) with diffuse intraperitoneal fluid collections (DIFC).


This study analyzed 117 patients with ruptured ALA who underwent US-PCD. The indication for US-PCD was failure to respond to conservative treatment and/or percutaneous needle aspiration.


Majority of patients were locally fermented alcohol abusers (95%), and malnourished (75%). Ninety-eight patients had intraperitoneal rupture including 66 contained rupture (CR) with localized intraperitoneal fluid collection (LIFC) and 32 FR with DIFC. Pleuropulmonary complication was found in 19 patients including 13 pleural and 6 pulmonary. A total of 333 catheters were used to drain 202 abscess cavities and associated fluid collections. US-PCD was technically and clinically successful in all cases. Multiple sessions (median 2; range 2–5) of PCD required with upsizing the catheter (median 14 F; range 14–20 F) and placement of additional catheter in 26 (22%) patients. The patients with FR with DIFC required more number of catheters (p = 0.01) and had longer hospital stay (p = 0.01). No major procedure related complication was observed. Six patients developed secondary bacterial infection; two of them presented with cavito-cutaneous fistula at catheter insertion site, and one with cholangitis due to biliary stricture formation necessitating subsequent endoscopic treatment. Post-procedural death occurred from sepsis in a patient with FR.


US-PCD is a safe and effective mode of treatment for ruptured ALA including FR with DIFCs. We recommend PCD as a first-line therapy for ruptured ALA.


Amebic liver abscess Ultrasound-guided percutaneous catheter drainage Ruptured liver abscess Amebic peritonitis Perforated liver abscess 



We thank Dr. Alok Ranjan, Assistant Professor, Community and Family Medicine, All India Institute of Medical Sciences, Patna, for performing the statistical analysis.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Our institutional review board approved this retrospective study and waived the requirement for informed consent.


  1. 1.
    Choudhuri G, Prakash V, Kumar A, Shahi SK, Sharma M (1991) Protective immunity to Entamoeba histolytica infection in subjects with antiamoebic antibodies residing in a hyperendemic zone. Scand J Infect Dis 23:771–776CrossRefGoogle Scholar
  2. 2.
    Kimura K, Stoopen M, Reeder MM, Monacada R (1997) Amebiasis: modern diagnostic imaging with pathological and clinical correlation. Semin Roentgenol 32:250–275CrossRefGoogle Scholar
  3. 3.
    Peters RS, Gitlin N, Libke RD (1982) Amoebic liver diseases. Ann Rev Med 32:161–174CrossRefGoogle Scholar
  4. 4.
    Sarda AK, Bal S, Sharma AK, Kapur MM (1989) Intraperitoneal rupture of amoebic liver abscess. Br J Surg 76:202CrossRefGoogle Scholar
  5. 5.
    Basile JA, Klein SR, Worthen NJ, Wilson SE, Hiatt JR (1983) Amebic liver abscess: the surgeon’s role in management. Am J Surg 146:67–71CrossRefGoogle Scholar
  6. 6.
    Eggleston FC, Handa AK, Verghese M (1982) Amebic peritonitis secondary to amebic liver abscess. Surgery 91:46–48Google Scholar
  7. 7.
    vanSonnenberg E, Ferrucci JT Jr, Mueller PR, Wittenberg J, Simeone J (1982) Percutaneous catheter drainage of abscesses and fluid collections: techniques, results and applications. Radiology 142:1–10CrossRefGoogle Scholar
  8. 8.
    vanSonnenberg E, Mueller PR, Schiffman HR, et al. (1985) Intrahepatic amebic abscess: indications for and results of percutaneous catheter drainage. Radiology 156:631–635CrossRefGoogle Scholar
  9. 9.
    Meng XY, Wu JX (1994) Perforated amebic liver abscess: clinical analysis of 110 cases. South Med J 87:985–990CrossRefGoogle Scholar
  10. 10.
    Akgun Y, Tacyildiz IH, Celik Y (1999) Amebic liver abscess: changing trends over 20 years. World J Surg 23:102–106CrossRefGoogle Scholar
  11. 11.
    Ken JG, vanSonnenberg E, Casola G, Christensen R, Polansky AM (1989) Perforated amebic liver abscess: successful percutaneous treatment. Radiology 170:195–197CrossRefGoogle Scholar
  12. 12.
    Baijal SS, Agarwal DK, Roy S, Choudhuri G (1995) Complex ruptured amoebic liver abscesses: the role of percutaneous catheter drainage. Eur J Radiol 20:65–67CrossRefGoogle Scholar
  13. 13.
    Stanley SL Jr (2003) Amoebiasis. Lancet 361:1025CrossRefGoogle Scholar
  14. 14.
    Miller FJ, Ahola DT, Bretzman PA, Fillmore DJ (1997) Percutaneous management of hepatic abscess: a perspective by interventional radiologists. J Vasc Interv Radiol 8:241–247CrossRefGoogle Scholar
  15. 15.
    Monga NK, Sood S, Kaushik SP, et al. (1976) Amebic peritonitis. Am J Gastroenterol 66:366–373Google Scholar
  16. 16.
    Basile JA, Klein SR, Worthen NJ, Wilson SE, Hiatt JR (1983) Amebic liver abscess: the surgeon’s role in management. Am J Surg 146:67–71CrossRefGoogle Scholar
  17. 17.
    Akgun Y, Tacyildiz IH, Celik Y (1999) Amebic liver abscess: changing trends over 20 years. World J Surg 23:102–106CrossRefGoogle Scholar
  18. 18.
    Liu CH, Gervais DA, Hahn PF, et al. (2009) Percutaneous hepatic abscess drainage: do multipleabscesses or multiloculated abscesses preclude drainage oraffect outcome? J Vasc Interv Radiol 20:1059–1065CrossRefGoogle Scholar
  19. 19.
    Radin DR, Ralls PW, Colletti PM, Halls JM (1988) CT of amebic liver abscess. AJR Am J Roentgenol. 150:1297–1301CrossRefGoogle Scholar
  20. 20.
    Tandon N, Karak PK, Mukhopadhyay S, Kumar V (1991) Amoebic liver abscess: rupture into retroperitoneum. Abdom Imaging 16:240–242Google Scholar
  21. 21.
    Agarwal DK, Baijal SS, Roy S, et al. (1995) Percutaneous catheter drainage of amebic liver abscesses with and without intrahepatic biliary communication: a comparative study. Eur J Radiol 20:61–64CrossRefGoogle Scholar
  22. 22.
    Wallace RJ Jr, Greenberg SB, Lau JM, et al. (1978) Amoebic peritonitis following rupture of an amoebic liver abscess. Successful treatment of two patients. Arch Surg 113:322–325CrossRefGoogle Scholar
  23. 23.
    Hai AA, Singh A, Mittal VK, Karan GC (1991) Amoebic liver abscess. Review of 220 cases. Int Surg 76:81–83Google Scholar
  24. 24.
    Kannathasan S, Murugananthan A, Kumanan T, et al. (2018) Epidemiology and factors associated with amoebic liver abscess in northern Sri Lanka. BMC Public Health 18:118CrossRefGoogle Scholar
  25. 25.
    Alam F, Salam MA, Hassan P, et al. (2014) Amebic liver abscess in northern region of Bangladesh: sociodemographic determinants and clinical outcomes. BMC Res Notes 7:625CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rajeev Nayan Priyadarshi
    • 1
    Email author
  • Vijay Prakash
    • 2
  • Utpal Anand
    • 3
  • Prem Kumar
    • 1
  • Ashish Kumar Jha
    • 4
  • Ramesh Kumar
    • 5
  1. 1.Department of Radio-DiagnosisAll India Institute of Medical SciencesPatnaIndia
  2. 2.Department of GastroenterologyPatna Medical College and HospitalPatnaIndia
  3. 3.Department of G.I. SurgeryAll India Institute of Medical SciencesPatnaIndia
  4. 4.Department of GastroenterologyIndira Gandhi Institute of Medical SciencesPatnaIndia
  5. 5.Department of GastroenterologyAll India Institute of Medical SciencesPatnaIndia

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