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Gastroenterology


Answer 6
  1. Percutaneous drainage of the abscess via interventional radiology. The patient has a large pyogenic abscess of unknown cause. Observation is insufficient given the patient’s risk for systemic sepsis and the need for drainage. Similarly, while aspiration of a small amount of fluid might yield helpful data, the lesion still needs to be drained. Endoscopic retrograde cholangiopancreatography would not be appropriate given the size of the lesion and the lack of known biliary disease. Percutaneous drainage, by either ultrasound or CT guidance, would be the fastest and least invasive option and would also allow placement of a drainage catheter. Surgical drainage would be reserved for patients who failed percutaneous drainage.

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