LAUSR

Drainage of pyogenic hepatic abscesses may be percutaneous, trans-enteric, or surgical. These abscesses are often multiloculated and may require multiple drainage catheters, repeated drain revision procedures, or surgical evacuations [1]. This report describes effective evacuation of multiloculated pyogenic abscesses using Inari Triever Aspiration Catheter (FlowTriever) in two patients who failed catheter drainages. Institutional review board approval was not obtained for preparation of this report. Patient 1: A 58-year-old male presented with right upper quadrant pain, nausea, and vomiting for 4 days. Patient was febrile (39 C), tachycardic (128 beats-permin), and hypotensive (78/51 mmHg). Patient had a leukocytosis of 13.73 9 10/lL [normal: 4.3–10.0 10/ lL]. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis demonstrated a 10.7 9 8.5-cm multilocular abscess in the right hepatic lobe. The patient was initially managed medically with broad-spectrum intravenous antibiotics. Blood cultures returned positive for Klebsiella pneumoniae. After 4 days of antibiotic therapy without clinical improvement, a 12-French drainage catheter was placed and applied to a Tru-Close Suction Drainage System (UreSil; Skokie, IL). Over the next 12 days, interval imaging demonstrated a persistent abscess with increased growth despite wire deloculation and drainage upsizing to 16 French (Fig. 1A). On hospital day 21, the patient underwent an abscessogram (drainage catheter interrogation) which demonstrated a persistent multiloculated abscess (Fig. 1B). The drainage catheter was removed and an 11-French sheath was placed. Mechanical maceration was performed with the ArrowTrerotola device (Teleflex; Wayne, PA) (Fig. 1C) given the presence of presumed thick, gelatinous debris. Next, largebore suction thrombectomy was performed, with three discrete aspirations, at multiple locations within the abscess, using a T16 Triever Aspiration Catheter (FlowTriever; Inari Medical; Irvine, CA) (Fig. 1D, E) until little additional debris was removed. A 16-French drainage catheter was replaced. Pathologic analysis was consistent with necrotic liver tissue, fibropurulent exudative debris, and abscess (Fig. 1F, G). There were no bacterial or fungal organisms. The catheter was downsized sequentially and removed on hospital day 30 following minimal drainage output, resolution of leukocytosis, and confirmation of abscess resolution on repeat CT (Fig. 1H). Patient 2: A 55-year-old female with metastatic mucinous appendiceal carcinoma and malignant biliary obstruction requiring biliary stenting presented with & Jeffrey Forris Beecham Chick [email protected]