PERCUTANEOUS PIGTAIL CATHETER VERSUS LARGE-BORE INTERCOSTAL CATHETER DRAINAGE IN LIVER ABSCESS: A COMPARATIVE STUDY WITH ILLUSTRATIVE CASES AND REVIEW OF CONTEMPORARY MANAGEMENT

Background: Liver abscess is an important intra-abdominal infective condition associated with significant morbidity whendiagnosis or source control is delayed. The two major forms encountered clinically are amoebic and pyogenic liver abscess,although fungal, tubercular and other uncommon causes may occur in selected patients. The management of liver abscesshas evolved considerably from conventional open surgical drainage to antimicrobial therapy combined with image-guidedpercutaneous intervention. Percutaneous needle aspiration and percutaneous catheter drainage are currently establishedminimally invasive approaches, while the choice between different catheter sizes is generally individualized according toabscess characteristics and technical accessibility. The objective is to compare the clinical and procedural outcomes ofpigtail catheter drainage and large-bore intercostal catheter (ICD) drainage in patients with liver abscess requiringpercutaneous management, and to review the historical evolution, indications, technical considerations, and contemporaryevidence regarding percutaneous drainage of liver abscess. Materials and Methods: A comparative analysis of 40 patientswith liver abscess requiring percutaneous drainage was performed: 20 patients were managed with a pigtail catheter and 20with a large-bore intercostal catheter (ICD). Clinical presentation, laboratory and imaging findings, catheter selection,duration of drainage, interval change in abscess cavity size, requirement for additional intervention, antimicrobial therapy,and duration of hospital stay were reviewed from clinical records. Three representative cases from the cohort are additionallypresented in narrative and imaging detail to illustrate the procedural technique and clinical course. Results: Patients in bothgroups presented with fever, chills, right upper quadrant pain, anorexia, malaise, and localized tenderness, with raisedinflammatory markers and hepatic collections confirmed on ultrasonography and/or contrast-enhanced CT, predominantlyinvolving the right lobe. The pigtail group generally comprised abscesses of approximately 6–12 cm, while the ICD groupincluded larger collections, generally approximately 9–15 cm, including posterior and subdiaphragmatic collections. Clinicalimprovement occurred within 48–72 hours in the pigtail group and within 24–48 hours in the ICD group. Catheter drainageduration ranged from 4 to 8 days in the pigtail group and 2 to 5 days in the ICD group, with corresponding hospital stays ofapproximately 5–9 days and 3–6 days. Follow-up imaging showed cavity reduction of approximately 62–82% in the pigtailgroup and 85–96% in the ICD group before catheter removal or discharge. Additional intervention for persistent or loculatedresidual collection was required in 4 of 20 pigtail patients compared with 1 of 20 ICD patients. Conclusion: Both pigtailcatheter drainage and large-bore ICD drainage achieved successful treatment of liver abscess. The large-bore ICD groupshowed comparatively faster clinical improvement, more rapid evacuation of the abscess cavity, greater early radiologicalreduction, shorter drainage duration, shorter hospital stay, and fewer additional drainage procedures, favouring its useparticularly for larger-volume and thick hepatic abscess collections, while pigtail catheter drainage remains a well-supported,effective option for smaller and moderate-sized, accessible, liquefied collections.