Novel, Minimally-Invasive Approach to Life-threatening, Complex Hepatic Abscess

In 2014, the world’s first percutaneous endoscopic debridement of hepatic abscesses was successfully performed by Matthew T. Moyer, M.D., at Penn State Hershey Medical Center. A report of the case was recently published in Gastrointestinal Endoscopy.¹ And, last October, a video of the procedure won first place in the international video forum competition at the 2014 American College of Gastroenterology Annual Conference in Philadelphia.2

Case SummaryIn a novel approach to treat a patient with life-threatening and complex hepatic abscess, Moyer explains that a multidisciplinary approach involving gastroenterologists, surgical oncologists and interventional radiologists was important, and that the approach was built on established principles of endoscopic treatment of pancreatic necrosis.3 “The successes that our interventional endoscopy group has had with endoscopic ultrasound-guided drainage and stenting of pancreatic pseudocysts as well as transluminal endoscopic debridement and washout of pancreatic abscess and necrosis inspired us to attempt adapting the technique to this patient as an alternative to high-risk open or laparoscopic hepatic necrosectomy, where mortality can be as high as 15 percent.”

Moyer notes that this particular case was unusual and challenging, saying, “The abscesses were extensive, bilateral, multi-locular and filled with solid necrotic debris, so initial placement of percutaneous drains did not lead to significant drainage.” Consequently, the drain ports placed by interventional radiologists were used to establish endoscopic access, then employing interventional endoscopy techniques to remove all solid debris, followed by high-volume saline lavage. A total of four procedures were performed over the course of 10 days to achieve thorough clearance of infected and necrotic tissue followed by progressive drain downsizing. Moyer adds, “The patient enjoyed a rapid recovery and was able to return to work and normal activity by week 10.”

Complex Hepatic Abscess

Successful endoscopic debridement and washout of bilateral hepatic abscesses over a series of four percutaneous necrosectomies. A: Enhanced MRI of the abdomen at the initial evaluation showing a large pyogenic abscess burden involving the right and left liver. B: The interior of the left liver abscess cavity as seen endoscopically during percutaneous debridement and lavage. C: CT imaging at 10 weeks from the first procedure confirming complete resolution of both liver abscesses.


Matthew T. Moyer, M.D.Matthew T. Moyer, M.D., M.S.
Associate Professor of Medicine
Phone: 717-531-3694 | E-mail: mmoyer@hmc.psu.edu
Fellowship: Gastroenterology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
Residency: Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
Medical School: Penn State College of Medicine, Hershey, Pennsylvania


References:

  1. Moyer MT, Gaffney RR, Gusani N, Waybill P, Schreibman I, Mathew A. Percutaneous endoscopic debridement and washout of a bilateral, loculated, hepatic abscess: A minimally invasive approach to a high risk surgical situation. Gastrointestinal Endoscopy. June 2015; 81(6): 1481-1482.
  2. Video of procedure: https://m.youtube.com/ watch?v=mo3IP4yn9to
  3. White SA, Sutton CD, Berry DP, Chillistone D, Rees Y, Dennison AR. 2000. Experience of combined endoscopic percutaneous stenting with ultrasound guidance for drainage of pancreatic pseudocycts. Ann R Coll Surg Engl. 82:11-5.

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