Challenges in Draining Liver Abscess: Risks and Treatment Options

The location of the liver abscess makes drainage impossible?

On December 1, 2021, I had a fever and went to the emergency room.
A CT scan of my abdomen revealed a liver abscess, which led to my hospitalization for treatment.
During my hospital stay, an abdominal ultrasound showed a liver abscess measuring 3.8 cm, located in the upper part of the liver.
The physician assessed that it was too close to the lungs, and performing drainage could potentially injure the lungs and cause a pneumothorax.
Therefore, drainage was not performed, and I was treated with antibiotic injections.
Additionally, blood and stool cultures did not reveal any bacteria.
I do not have diabetes, and blood tests during my hospitalization indicated that my white blood cell count had returned to normal.
I was discharged on December 18 and switched to oral antibiotics with outpatient follow-up.
Currently, my daily body temperature ranges from 36.8 to 37.1 degrees Celsius in the morning and noon, but it can rise to 37.3 degrees in the evening and then drop back to 37.0 degrees at night.

I have two questions:
1.
Is it really impossible to perform drainage for my liver abscess? Will not performing drainage increase the risk of the liver abscess leading to other infections or complications?
2.
Is my temperature fluctuation normal?

Niming, 40~49 year old female. Ask Date: 2021/12/23

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to closely cooperate with the physician for follow-up, providing a daily temperature log for three meals.
If the fever exceeds 38 to 39 degrees Celsius, return for an earlier consultation or visit the emergency department.

Reply Date: 2021/12/23

More Info

Draining a liver abscess presents several challenges and risks, particularly when the abscess is located in a position that complicates access. In your case, the abscess is situated near the lung, which raises concerns about potential complications such as pneumothorax if drainage is attempted.
1. Drainage Feasibility: The decision not to drain the abscess was likely made based on the risk-benefit analysis conducted by your healthcare team. When an abscess is located close to vital structures, such as the lungs, the risks of invasive procedures may outweigh the benefits. In some cases, abscesses can resolve with antibiotic therapy alone, especially if they are small and the patient is otherwise stable. However, if the abscess does not respond to antibiotics or if it increases in size, reconsideration of drainage options may be necessary.
2. Risk of Complications: Not draining the abscess can lead to potential complications, including the risk of the abscess enlarging, rupturing, or leading to secondary infections. Continuous monitoring through imaging studies and clinical evaluation is essential to ensure that the abscess is not causing further complications. If there are signs of worsening symptoms, such as increased fever, abdominal pain, or changes in liver function tests, further intervention may be warranted.

3. Temperature Fluctuations: Regarding your temperature changes, it is not uncommon for patients recovering from an infection to experience fluctuations in body temperature. A low-grade fever, particularly in the evening, can be a normal response as the body continues to fight off infection. However, persistent or rising fevers could indicate ongoing infection or complications, and it is crucial to communicate any concerning symptoms to your healthcare provider.

In summary, while drainage of a liver abscess is often the preferred treatment, the specific circumstances surrounding your case necessitated a cautious approach. Continuous follow-up and monitoring are critical to ensure that the abscess resolves and does not lead to further complications. If you have any concerns about your recovery or the management of your liver abscess, do not hesitate to reach out to your healthcare team for guidance and support. They can provide personalized advice based on your clinical status and any new developments in your condition.

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