Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial Comparative study of catheter drainage and needle aspiration in management of large liver abscesses Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Indications for aspiration of amoebic liver abscess. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration Needle aspiration in large amoebic liver abscess. Management of large amoebic liver abscess--a comparative study of needle aspiration and catheter drainage. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. Comparative study of three antimicrobial drugs protocol (Ceftriaxone, Gentamicin/Amikacin and Metronidazole) versus two antimicrobial drugs protocol (Ceftriaxone and Metronidazole) in cases of intra-abdominal sepsis. Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration. Prophylactic metronidazole in appendectomy: a double-blind controlled trial. Efficacy of aspiration in amebic liver abscess. Needle aspiration of amoebic liver abscess. Subcuticular Skin Closure as a Standard Approach to Emergency Appendectomy in Children: Prospective Clinical Trial
Summary Amoebic liver abscess develops in less than 1 % of patients with amoebaisis and metronidazole is the drug of choice for the treatment of amebic liver abscess . Abscesses of less than 5 cm can be treated with metronidazole alone . However , abscesses of more than 10 cm must undergo ultrasound guided percutaneous needle aspiration along with metronidazole . The role of percutaneous needle aspiration in abscesses of 5 to 10 cm is not clear . Fifty-seven patients with a solitary , right lobe , uncomplicated amoebic liverabscess of 5–10 cm were r and omized to receive either metronidazole alone ( control group ; n = 29 ) or ultrasound guided percutaneous needle aspiration along with metronidazole ( intervention group ; n = 28 ) . Although the resolution of pain and fever occurred earlier in the intervention group ( 27 h and 17 h , respectively ) than the control group ( 48 h and 30 h , respectively ) , the difference was not statistically significant ( P = 0.16 and 0.48 , respectively ) . There were no deaths during the study period and treatment failure , complications ( rupture of abscess ) , days to normalization of leukocytosis and duration of hospitalization were similar in both groups . Ultrasound guided percutaneous needle aspiration along with metronidazole was no better than metronidazole alone in the management of uncomplicated , solitary , right lobe amoebic liver abscess of 5 to 10 cm Objective To compare the effectiveness of percutaneous catheter drainage ( PCD ) and percutaneous needle aspiration ( PNA ) in the management of large ( > 10 cm diameter ) liver abscesses . Methods Seventy-two patients with liver abscess ( amebic 48 , pyogenic 24 ) were r and omly allocated to PCD or PNA ( 36 each ) , which were done within 24 hours of admission . Both groups received parenteral antibiotics for at least 10 days . PNA was repeated every third day if the cavity size had not declined to 50 % of the original for up to three times . Persistence of cavity or of clinical symptoms was considered failure of treatment . Duration to attain clinical relief , duration of hospital stay , complications , treatment failure , and deaths were recorded . Results PNA was successful in 31 of 36 ( 86 % ) patients ( one aspiration in 10 , two in 18 , and three in 3 patients ) , whereas PCD was successful in 35 ( 97 % ) patients ( p = ns ) . Duration to attain clinical relief ( 10.2 [ 2.0 ] vs. 8.1 [ 2.7 ] days ; p=0.02 ) and parenteral antibiotics needed ( 15.5 [ 1.1 ] vs. 10.9 [ 2.7 ] days ; p=0.04 ) were significantly lower in PCD group . Duration of hospital stay was similar in the two groups . One patient with PNA had a subcapsular hematoma and one with PCD had continuous bile leakage which stopped spontaneously . One patient in PCD group died . Conclusion PCD is a better treatment option than PNA for the management of large liver abscesses of size > 10 cm , in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses . Over a 5-year period , 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics ( ampicillin , cefuroxime , and metronidazole ) and r and omized into two percutaneous treatment groups : continuous catheter drainage ( with an 8F multi-sidehole pigtail catheter ) ; and intermittent needle aspiration ( 18 G disposable trocar needle ) . There was no statistically significant difference between the two groups regarding patient demographics , underlying coexisting disease , abscess size , abscess number , number of loculation of abscess , the presenting clinical symptoms such as fever , abdominal pain , and pretreatment liver function test . Although not statistically significant , the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group , and the change of antibiotics after the sensitivity test was more frequent with the needle group . The needle group was associated with a higher treatment success rate , a shorter duration of hospital stay , and a lower mortality rate , although this did not reach statistical significance . In conclusion , this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess , although further proof with a large-scale study is necessary . Due to the additional advantages of procedure simplicity , patient comfort , and reduced price , needle aspiration deserves to be considered as a first-line drainage approach OBJECTIVE The purpose of this study was to determine the effectiveness of percutaneous catheter drainage ( PCD ) and to compare PCD with percutaneous needle aspiration in the management of liver abscess . SUBJECTS AND METHODS Sixty patients with pyogenic liver abscess were r and omly assigned to two groups in a prospect i ve study . Antibiotics were administered for 10 days , starting the day of the beginning of percutaneous treatment . One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration . Percutaneous needle aspiration was attempted a maximum of three times . Lack of response to the third aspiration was considered failure of treatment ; these patients were treated with PCD but were not included in the PCD group for analysis . Patient demographics , duration of hospital stay , treatment outcome , and complications were analyzed . RESULTS Percutaneous needle aspiration was successful in 20 ( 67 % ) of the 30 patients after one ( n = 12 ) , two ( n = 7 ) , or three ( n = 1 ) aspirations . PCD was curative in all 30 patients after one ( n = 24 ) or two ( n = 6 ) procedures . All abscesses 50 mm or less in longest diameter were successfully managed , 10 by percutaneous needle aspiration and 12 by PCD . None of patients in the percutaneous needle aspiration group with multiloculated abscesses ( n = 5 ) was successfully treated . Hospital stay did not differ significantly between the groups . There were no complications related to the procedure . CONCLUSION PCD is more effective than percutaneous needle aspiration in the management of liver abscess . Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller A two-part study was undertaken to determine whether aspiration of amoebic liver abscess ( ALA ) prevents complications .  Eighty patients studied prospect ively were r and omised into aspiration or non-aspiration groups and were treated with metronidazole . Common factors in patients with complicated diseases were determined to formulate and test indications for aspiration . Records of all patients with ALA admitted to King Edward VIII Hospital , Durban , between October 1983 and December 1984 were analysed to test the validity of the criteria derived from the first part of the study . The findings suggest that aspiration influences the course and outcome of ALA and that the criteria are valid although not necessarily complete Background The aim of the study was to evaluate the clinical presentation , and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses . Methods This is a prospect i ve r and omized comparative study of 60 patients , presented in outpatient and emergency department at the hospital , r and omized equally into two groups , percutaneous needle aspiration and pigtail catheter drainage .  The effectiveness of either treatment was measured in terms of duration of hospital stay , days to achieve clinical improvement , 50 % reduction in abscess cavity size and total/near total resolution of abscess cavity . Independent t-test was used to analyze these parameters . Results The success rate was significantly better in catheter drainage group ( P=0.006 ) . The patients in pigtail catheter drainage group showed earlier clinical improvement ( P=0.039 ) and 50 % decrease in abscess cavity volume ( P=0.000 ) as compared to those who underwent percutaneous needle aspiration . Conclusion Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus The role of percutaneous needle aspiration for therapy of uncomplicated , large amoebic liver abscess ( ALA ) is not defined . Twenty nine patients of ALA with a cavity larger than 5 cm were r and omised to two groups : ( i ) metronidazole 800 mg tid for 10 days combined with needle aspiration ( group A , n = 15 ) and ( ii ) metronidazole therapy alone ( group B , n = 14 ) . Clinical parameters , viz , fever , pain and abdominal tenderness were recorded daily and grade d 0 to 3 ( in order of increasing severity ) . A statistically significant benefit was demonstrated in group A for clinical parameters evaluated . Group A patients took less time to become afebrile from the grade 2 level as compared to group B ( 3.8 + /- 1.7 days and 5.6 + /- 2.2 days respectively ; p < 0.05 ) . Reduction in pain intensity and abdominal tenderness from grade 2 to 1 also occurred earlier in group A ( 0.7 + /- 0.7 days vs 2.9 + /- 0.9 days for pain , P < 0.001 and 1.7 + /- 0.8 days vs 2.9 + /- 1.2 days for abdominal tenderness , p < 0.001 ) . The mean duration of hospitalization was significantly shorter in group A as compared to group B ( 5.8 + /- 0.8 days vs 7.4 + /- 1.5 days , p < 0.001 ) . Improvement in haematological and biochemical variables was similar in both groups . We conclude that percutaneous therapeutic needle aspiration of uncomplicated , large ALA hastens clinical recovery Amoebiasis in endemic in the tropical countries with amoebic liver abscesses being a common complication . Different modalities of treatment of amoebic liver abscess are conservative ( medical management ) , percutaneous needle aspiration , percutaneous catheter drainage , surgical drainage and endoscopic drainage . This study was carried out to compare the efficacy , safety and outcome of needle aspiration comparing with percutaneous catheter drainage of large ( > or = 5 cm diameter ) amoebic liver abscesses . This was a prospect i ve study carried over a period of two years ( 2006 - 2008 ) at the general surgery department of Calcutta National Medical College and Hospital , Kolkata . A total of 45 patients were included in this study . All of them had amoebic liver abscess with diameter of abscess cavity > or = 5 cm . They were divided into two groups . Group A included 22 patients and they were treated with needle aspiration . Group B included 23 patients and they were treated by catheter drainage . Improvement in clinical features , liver function tests , ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment . The sex ratio and the age incidence in the two groups were similar . In about 80 % patients the right lobe was affected , in about 18 % the left lobe was affected and in rest the abscess involved both lobes . Needle aspiration was successful in 15 ( 68.2 % ) and catheter drainage was successful in 23 patients ( 100 % ) . The mean hospital stay of patients treated with needle aspiration was more than those treated with catheter drainage . The mean time in days taken for 50 % decrease in the size of abscess cavity was significantly greater in group treated with needle aspiration than in those treated with catheter drainage ( 9 days versus 4 days ) . It is concluded that percutaneous catheter drainage is more effective in management of large amoebic liver abscess than needle aspiration Thirty-nine patients with amoebic liver abscess ( ALA ) , admitted to the Central Hospital of Hué ( Vietnam ) , were evaluated in a comparative , prospect i ve and r and omized study for the treatment of ALA . Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included . Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients . Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration . The clinical symptoms fever , pain in right upper abdomen and liver tenderness , and the laboratory parameters erythrocyte sedimentation rate , white blood cells , haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days . Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days ( P < 0.001 ) , whereas all the other parameters showed no differences between the two groups . This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe OBJECTIVE This study was design ed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses . SUBJECTS AND METHODS In a r and omized study , 50 patients ( 38 males and 12 females ; age range , 2 - 72 years ; average age , 35 years ) with liver abscesses ( amebic , 20 ; pyogenic , 11 ; indeterminate , 19 ) underwent either percutaneous needle aspiration ( n = 25 ) or catheter drainage ( n = 25 ) along with appropriate antimicrobial therapy . In patients assigned to the needle aspiration group , an 18-gauge needle was used to aspirate the abscess cavity . Repeated aspiration was attempted only once in each patient not responding to the first aspiration ; nonresponse to the second aspiration was considered failure of treatment , and these patients were given catheter drainage ( however , these patients were not included in the catheter drainage group ) . For catheter drainage , 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique . In patients with multiple abscesses ( seven in aspiration group and five in catheter group ) , all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment . Patients were followed up to assess the outcome of the percutaneous treatment , length of hospital stay , and development of any complications .  Sonography was performed every third day during hospitalization . After discharge of the patient , periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved . RESULTS Although percutaneous needle aspiration was successful in only 15 ( 60 % ) of the 25 patients after one ( n = 11 ) or two ( n = 4 ) aspirations , catheter drainage was curative in all 25 patients ( 100 % ) ( p < .05 ) . Among the successfully treated patients , the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups . Although the average time needed for a 50 % reduction in the size of the abscess cavity was significantly ( p < .05 ) greater in the aspiration group than in the catheter group ( 11 days versus 5 days ) , the average time taken for total resolution of abscess was the same ( 15 weeks ) in both groups . No major complications were encountered . No relapse was documented on clinical and sonographic examination during follow-up , which ranged from 8 to 37 weeks . CONCLUSION Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses . Needle aspiration , if limited to two attempts , has a high failure rate BACKGROUND Treatment of intra-abdominal sepsis with antibacterial drugs should be initiated as soon as possible diagnosis is made before surgery and continued in the post operative period , unless required to be changed ( when there is no satisfactory clinical response ) . The ideal agent ( s ) and duration of therapy remains somewhat controversial . However , early experimental and subsequent clinical studies have indicated that the spectrum of chosen antibacterial activity must encompass both colonic aerobes and anaerobes including B. fragilis . There are a number of multi drug protocol s that are used to treat intra-abdominal septic conditions . Empiric use of these protocol s not only adds toxicity to already ill patient but therapy becomes costly and utilizes human re source , unnecessarily . AIM OF STUDY To study the clinical efficacy of the treatment of intra-abdominal sepsis with protocol -A ( Ceftriaxone , Metronidazole and aminoglycoside ) versus protocol -B. ( Ceftriaxone and Metronidazole ) . MATERIAL AND METHODS This is a prospect i ve r and omized study conducted at NGMC , Nepalgunj , Nepal ( 2003 - 2004 ) on the patient attending for the treatment of intra-abdominal sepsis . Patients included in this study were of inflammation , obstruction with or without gangrene and perforation of appendix , small bowel and large bowel with localized or generalized peritonitis . These patients were managed surgically by- appendicectomy , closure of perforation , resection and anastomosis ( R & A ) and resection and proximal colostomy .  Patients of large bowel obstruction without gangrene and small bowel gangrene were managed by R & A. These patients had significant faecal spillage at the surgical site as well as in the peritoneum . At the end of operation peritoneum and surgical site of all cases were washed with saline and povidone-iodine solution . They were put on one of the two protocol s for post-operative treatment . A total 59 patients were included in this study . 32 cases were treated with protocol - A and rest 27 cases were treated with protocol - B. These cases were selected r and omly for this study . Their outcome was compiled and compared under following headings : postoperative recovery , postoperative pyrexia , wound infection and dehiscence , anastomotic leak , residual abscess and cost of therapy . STATISTICAL ANALYSIS Statistical analysis was done with the help of Chi square test . RESULT Of the 59 patients , 32 were r and omized to group I , 27 to group II . These groups were comparable in age , weight , sex and duration of therapy . Uneventful recovery was noted in 87.5 % ( 28/32 ) in -group I where as in 70.37 % ( 19 /27 ) in-group II . Complications were observed in 12.5 % in-group I where as 29.63 % in-group II . 10 patients in-group I where as 7 patients in -group II had surgical site infections ( SSIs ) . All of these had superficial wound infection with/or without dehiscence of small portion of wound . A single case of residual abscess and anastomotic leak was observed . Postoperative pyrexia was noted in 8 patients in-group I where as in 6 patients in-group II . In pyrexia , temperature ranged from 99 - 104 0F . Finally except one case , rest of the cases recovered . On follow up after 3weeks , the cases recovered were doing well . CONCLUSION At least three conclusions can be drawn from this study . Firstly protocol A is equally effective as protocol B. Secondly ; it appears that combining aminoglycoside with Ceftriaxone therapeutically has no significant ( P = 0.09 ) benefit over Ceftriaxone alone . Finally protocol A is less expensive in terms of total therapy than protocol B and can be used without fear even in subnormal functioning kidney Objectives To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage ( PCD ) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments . Methods Eighty-one patients with severe acute pancreatitis ( SAP ) were admitted and divided into three groups : forty-nine cases in the conservative therapy group ; nineteen cases in the surgery group ; and thirteen cases in the PCD therapy group . Forty-five patients with a CT severity index ( CTSI ) ≤ 8.0 received conservative treatment . One patient with CTSI = 7.0 underwent surgery . Thirty-five patients with a CTSI > 8.0 were r and omly selected for surgery or PCD treatment . After r and omization , six patients ( four patients in the surgery group and two patients in the PCD group ) were dropped from the study . The total number of patients included in the surgery and PCD groups was sixteen and thirteen , respectively . Results Four patients ( 8.2 % ) in the conservative therapy group died , five patients ( 31.3 % ) in surgery group with a CTSI > 8.0 died , and all patients in the PCD group survived . The mortality rate was lower in the PCD group than in the surgery group ( P = 0.048 ) . The serum C-reactive protein ( CRP ) level recovered more quickly in patients in the PCD group compared to those in the surgery group ( P < 0.001 ) . Conclusions Patients with SAP and a CTSI ≤ 8.0 could be treated with conservative therapy , while patients with a CTSI > 8.0 should be treated with surgery or PCD therapy if the life-threatening complications of extensive fluid collection or necrosis are a factor . However , PCD therapy used in a timely manner for drainage may decrease mortality in patients with SAP , decrease inflammatory mediator release , and avoid incidence of severe sepsis or acute respiratory distress syndrome ( ARDS ) and emergency surgery The performance of therapeutic aspiration in the treatment of amebic liver abscess , advocated and practice d in many centers , is controversial . Previously , this practice has been evaluated in retrospective analyses . To test the potential benefit of therapeutic aspiration , the authors undertook a prospect i ve r and omized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period . Sixteen patients were excluded from the trial . The remaining 41 patients were r and omly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration . All patients in the trial recovered . No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated : length of hospitalization and duration of time to becoming afebrile . Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level . These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess . Amebicidals alone were equally efficacious in treating the group studied Ninety-eight patients with suspected nonperforated acute appendicitis have to date been entered into a continuing , prospect i ve , blinded r and omized trial to determine the role of prophylactic metronidazole in postoperative wound infection . Twenty-six patients were excluded for the following reasons : diagnosis other than acute appendicitis ( 16 ) , perforation of the appendix ( 8) , administration of other antibiotics ( 1 ) , and refusal to enter study ( 1 ) . Seventy-two patients , 47 men and 25 women , with a mean age of 27.5 years ( range 15 to 60 years ) , underwent appendectomy and were studied . Thirty patients received 1 gm intravenous metronidazole preoperatively and five intravenous doses of 500 mg metronidazole postoperatively . Forty-two patients received placebo only . Cultures of the appendiceal stump grew aerobic cultures in 45 ( 62 % ) and anaerobic organisms in 29 ( 40 % ) : Escherichia coli and Bacteroides fragilis , respectively . Six of the 72 patients ( 8.2 % ) developed postoperative wound infections : four of 42 ( 9.5 % ) who received placebo and two of 30 ( 6.6 % ) who received metronidazole ( P = 0.54 by Fisher exact test ) . No toxicity from metronidazole  was observed . The postoperative wound infection rate is insufficient to demonstrate the efficacy of metronidazole for prophylaxis in nonperforated acute appendicitis , although there appears to be a tendency of to assume its efficacy in this regard BACKGROUND Amebic liver abscess ( ALA ) is a common and serious problem in our country . There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy , over pharmacotherapy alone for amebic liver abscess . MATERIAL AND METHODS This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small ( up to 5 cm ) and large ( 5 cm to 10 cm ) size ALA . This is one of the largest single center , prospect i ve , r and omized studies comparing the efficacy of aspiration in ALA . RESULTS ( i ) Mean body temperature , liver tenderness , total leukocyte count ( TLC ) , serum alanine aminotransferase ( ALT ) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess ( 5 cm to 10 cm ) . ( ii ) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15 , and 1 month & 3 months in large abscess ( 5 cm to 10 cm ) . CONCLUSIONS ( i ) Needle aspiration along with metronidazole hastens clinical improvement especially in large ( 5 cm up to 10 cm ) cavities in patients with ALA . ( ii ) Aspiration is safe and no major complications occurred . ( iii ) Hence , combination therapy should be the first choice especially in large ALA ( 5 cm to 10 cm ) OBJECTIVE --To determine the value of needle aspiration in uncomplicated amoebic liver abscess . DESIGN --R and omised case-control study with a minimum follow up of one year , comparing patients treated with drugs alone with those treated with additional needle aspiration . SETTING --Referral based gastroenterology clinic . PATIENTS --39 Consecutive patients with amoebic liver abscess in the right lobe , of whom 37 completed the study . INTERVENTION -- Metronidazole 2.4 g/day was given to all patients for 10 days . Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital . MAIN OUTCOME MEASURES --Abdominal pain , fever , anorexia , and hepatomegaly were measured . Erythrocyte sedimentation rate , serum aspartate , and alanine aminotransferase activities , and alkaline phosphatase activity were also measured . RESULTS -- Clinical improvement was similar in both groups of patients . Improvement in haematological and biochemical variables and rates of healing of cavities were also similar . CONCLUSIONS --Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess , and in uncomplicated cases routine aspiration is not required Abstract . We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures  following emergency appendectomy .  In a prospect i ve clinical trial over a 12-month period , 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4 - 0 sutures . Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis ; a combination of metronidazole , gentamicin , and ampicillin was used when perforation of the appendix was suspected . Postoperatively , in patients with phlegmonous appendicitis  metronidazole was given for 24 hours , whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days . All patients were assessed for complications result ing from the technique of wound closure . No intraabdominal abscesses or serious complications were recorded . The overall incidence of wound infection was 1.8 % . Among children with a perforated appendix the rate of superficial wound infection was 5.7 % . There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively . All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary . We conclude that the use of prophylactic antibiotics permits st and ard skin closure by interrupted absorbable subcuticular suture
There was no significant difference in relation to the resolution of fever , abscess size , and hospital stay .
The beneficial effects of PA were seen with medium-to-large ( > 5 cm ) ALA and not with small ( < 5 cm ) ALA .
Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA .
Percutaneous catheter drainage is better for larger ALA .
The role of metronidazole alone , percutaneous aspiration ( PA ) , and percutaneous catheter drainage ( PCD ) in the treatment of uncomplicated amebic liver abscess ( ALA ) is still unclear .
This systematic review and meta- analysis evaluated the available evidence s with regard to treatment modalities in such patients .