The patient was a 55-year-old male with recurrent fever for 10 days, temperature 39 degrees, blood leukocyte 13.1, albumin 24, CT examination showed right lobe of liver with intrahepatic bile duct pneumatosis, perihepatic effusion, splenic hypodensity shadow, right lobe of liver abscess, treated with penicillin, cephalosporins, phosphomycin, imipenem and moxifloxacin and methylprednisolone, dexamethasone, etc. Symptoms were not relieved. Preoperative CT After admission, a percutaneous puncture liver abscess was placed and drained with lavage, and 30 ml of pus was aspirated during the operation. After the operation, the tube was repeatedly irrigated with metronidazole for 5 times through the drainage tube, and the tube was removed when the pus cavity was reduced. CT combined with X-ray guided percutaneous puncture for liver abscess placement Aspiration of pus Lavage of pus cavity with metronidazole Gentamicin 2 months CT follow up, abscess disappeared. Methods and indications for percutaneous liver aspiration for bacterial liver abscesses Percutaneous liver aspiration is mainly indicated for solitary abscesses larger than 3 cm in diameter. Ultrasound has a high accuracy in the diagnosis of liver abscess, and ultrasound-guided puncture not only provides a reliable basis for diagnosis, but also provides a safe and efficient treatment, combining diagnosis and treatment, and is the first choice for the examination and treatment of bacterial liver abscess. Percutaneous aspiration of pus should be done as cleanly as possible, and the pus should be sent for routine and biochemical examination, bacterial culture plus drug sensitivity and tumor cytology. If the pus is viscous and not easy to be aspirated, gentamicin saline can be used to dilute it and then aspirate it, or an external suction device can be used for continuous negative pressure aspiration. After the pus is extracted, the pus cavity is repeatedly flushed with gentamicin or metronidazole solution at low pressure until the retrieved fluid is basically clear or light blood, the flushing fluid is aspirated, and gentamicin 160,000 U is injected into the pus cavity. antibiotics are routinely applied for 4-6 weeks postoperatively and adjusted according to the drug sensitivity results, if no bacteria are cultured, it may be due to anaerobic bacteria. At the same time, strengthen nutritional support therapy, correct acid-base imbalance and water-electrolyte disorders, intermittently transfuse plasma or albumin, monitor body temperature and recheck blood routine, and strictly control blood sugar in diabetic patients. Ultrasound was repeated 3-7 d after surgery, and repeat puncture was required if liquefied cavity was still present. Tian Ruixia et al [12] reported 67 cases of liver abscesses, all of which were cured by ultrasound-guided puncture and pus aspiration combined with antibiotic treatment, with significantly shorter healing time than the surgical group, no complications or recurrence, and 100% puncture success rate. Xiang Ming et al [13] reported 36 cases of liver abscess patients with percutaneous puncture drainage and 20 cases of transabdominal surgical drainage, and the puncture group was significantly better than the surgical group in terms of resumption of normal diet, drainage time, antibiotic application, hospitalization time, number of transfusion cases and complication rate, with a puncture success rate of 91.7%. Percutaneous liver puncture and drainage Percutaneous puncture and placement of a single tube for drainage is used when the abscess is 5-10 cm in diameter, the abscess is incompletely liquefied or the pus is viscous and there is necrotic tissue, and it is estimated that the pus cannot be easily drained at once, a 12-18F catheter is placed as needed or an 8F pigtail catheter is placed into the abscess cavity using the arteriography Seldinger method, and multiple abscess cavities are placed separately for drainage. Jia Zhong et al. reported 10 cases of liver abscesses, which were drained by CT-guided Bard puncture drainage device, all of which were successfully placed in one visit without serious complications such as hemorrhage, bile leak, or peritonitis, with a 100% cure rate and no recurrence after discharge. The advantages of the pigtail tube over other drains are that its small diameter facilitates the reduction of injury and bleeding, its moderate stiffness and multiple lateral holes can effectively ensure drainage, and the curled head end can prevent the catheter from slipping out. Depending on the size of the pus cavity, the cavity can be flushed with appropriate amount of saline plus gentamicin and 0.5% metronidazole solution 2 to 3 times a day for 3 to 5 d. If there is more necrotic tissue, 5% sodium bicarbonate or α-chymotrypsin can be added to the flushing to dissolve the necrotic tissue and dilute the pus to facilitate aspiration. After irrigation, the cavity was kept for 1 h with the appropriate antibiotics, and the drainage was then re-drained, paying attention to the consistency of the antibiotics used for local irrigation and systemic medication. When the patient’s body temperature returns to normal, the pain disappears, the white blood cell count and classification return to normal, the drainage fluid is clear or yellowish (containing bile), the daily drainage is less than 10 ml, the ultrasound shows the basic disappearance of the abscess cavity (manifested as a disorganized echogenic area, which can be accompanied by acoustic shadowing posteriorly), and the abscess is significantly reduced (diameter <3 cm or diameter reduction >50%), it can be regarded as an indication for extubation. Bacterial liver abscess is a purulent lesion caused by the invasion of septic bacteria into the liver, and the mortality rate is still as high as 11%-31%. When the abscess is small or not yet confined to liquefaction, it is mainly treated with systemic antibiotics. If the disease is long, the abscess wall is thickened and the abscess cavity is isolated from the hepatic sinusoids, it is difficult for antibiotics to enter the abscess cavity, or if the abscess is large (>5 cm), has a large amount of pus, or forms multiple abscesses, antibiotics alone cannot completely control the infection, so drainage of the pus becomes necessary. Traditional open drainage has a tendency to be gradually replaced by percutaneous puncture and drainage treatment due to high risk of trauma and anesthesia, long recovery time, and many complications, etc. Surgical treatment is still needed when percutaneous puncture and drainage fails for various reasons or when there are contraindications to puncture and drainage treatment.