A 56-year-old diabetic man presents with fever, right upper quadrant pain, and a 7 cm multiloculated liver abscess. Blood culture grows Klebsiella pneumoniae. He is haemodynamically stable. The most appropriate initial management is:

• A Broad-spectrum antibiotics alone for 6 weeks
• B Right hepatectomy
• C Open surgical drainage via a subcostal incision
• D Percutaneous aspiration or catheter drainage with antibiotics ✓

Explanation

Klebsiella is the leading organism in pyogenic liver abscess among diabetic patients in Asia, and hypervirulent strains cause monomicrobial abscesses. For an abscess larger than about 5 cm in a stable patient, image-guided percutaneous drainage combined with antibiotics is the established first-line treatment. Antibiotics alone fail in large collections, open drainage is reserved for failed percutaneous drainage, ruptured abscess, or thick multiloculated pus, and resection has no role here.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.