A 60-year-old man with poorly controlled diabetes presents with fever, right upper quadrant pain, and jaundice of one week. CT shows a multiloculated 7 cm collection in the right lobe with rim enhancement and gas locules. Blood culture grows Klebsiella pneumoniae. After antibiotics, what is the most appropriate next step?
- A Percutaneous catheter drainage of the collection ✓
- B Metronidazole monotherapy and observation
- C Open surgical drainage via a subcostal incision
- D Right segmentectomy of the involved lobe
Correct answer: A. Percutaneous catheter drainage of the collection
Explanation
Gas-forming, multiloculated pyogenic liver abscess caused by Klebsiella in a diabetic is a recognised entity. Treatment combines broad-spectrum antibiotics covering gram-negative organisms and anaerobes with source control by image-guided percutaneous aspiration or catheter drainage, which is now first-line for abscesses larger than about 5 cm or those failing antibiotics. Surgery is reserved for failed percutaneous drainage, thick multiloculated pus, ruptured abscess, or underlying pathology needing correction.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.