Clinical study on the various therapeutic approaches towards the management of hepatic abscess in adults

Farman Ali, Ravikar Jayaraj, Deepti N Rao, Mohammed Arafath Ali, Avinash K, Raksha L, Anagha P Rao, Rakshith M, Pooja P Jain

Abstract


Background and objectives: Hepatic abscess is a very common and significant health condition in developing countries including India. Alcohol consumption is one of the most important predisposing factors in causation of hepatic abscess followed by uncontrolled diabetes and immunosuppression. The aim of this study was to device a definitive protocol in the management of patients with liver abscess and to evaluate the different treatment option of liver abscess, amoebic or pyogenic in order to have some guidelines in our setting

Material and methods: A hospital based prospective study was conducted between August 2014 to September 2016 in Bangalore medical and research institute (Victoria hospital and Bowring & Lady Curzon Hospital), Bangalore.  The following study was done in a set of 50 patients diagnosed with liver abscess admitted in our hospital. After confirming the diagnosis, patients were exposed to different treatment modalities which consisted of medical management alone, USG guided Aspiration, Pigtail catheterization and exploratory laparotomy.

Results: In our study majority of the patients (84%) were of amoebic liver abscess (ALA) and only 16% were of pyogenic liver abscess (PLA).  Out of 50 patients 8 patients responded to drug therapy alone, 40 patients underwent ultrasound-guided aspiration and pigtail catheter placement and 2 patients were treated with CT guided aspiration. Open surgical method was excluded in our study.

Conclusion: Image guided drainage is the best modality of treatment for liver abscess size >4cm in both pyogenic and amoebic liver abscess however in small size abscess medical management is equally good. Abscess cavity resolves better and has a lower recurrence rate in case of percutaneous catheter drainage than percutaneous needle aspiration.. Mortality was not observed in our series. Prompt diagnosis, aggressive medical treatment along with minimal intervention can keep the morbidity and mortality associated with this condition to a bare minimum.


Keywords


Abscess,drainage,catheter,percutaneous,amoebic,pyogenic

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References


. Surgery of the liver and biliary tract. Blumgart L H; Vol ll (3'd ed): 1 147-66.

. Bhatti A, Ali F, Satti S, Satti T. Clinical & pathological comparison of Pyogenic and Amoebic liver abscess. Advances in Infectious Diseases 2014;4:77-123.

. Kapoor OP. Amaoebic liver abscess, 1st eds, SS Publishers, Bombay, 1999.

. Wintch RW, Reines HD, Rambo WM. Liver abscess: A changing entity. Am Surg 1982; 48:11-5.

. Davis A, Pawloski ZS. Amoeblasis and its control: A WHO meeting. Bulletin of WHO 1985; 63: 417-426.

. DeBakey, M E,and Ochsner, A, Surg Gyn. obst.(I. A. S.), 1951,92, 209.

. Ananthakrishnan Ramani, Rama Ramani, P G Shivananda, Amoebic Liver Abscess: A Prospective Study Of 200 Cases In Rural Referral Hospital In South India, Bahrain Medical Bulletin, 1995; 17

(4).

. Dr M R Rajasekar , Liver Abscess ,Global Healthcare Solution , 2001-2007 Liverindia.Com

. Qurban Ali Bugti, Mohammad Aslam Baloch, Ahsanul Wadood, Akhter Hameed Mulghani , Bushra Azeem And Jameel Ahmed, Pakistan Medical Research Council, Bolan Medical College, Quetta, Pyogenic Liver Abscess: Demographic, Clinical, Radiological And Bacteriologiocal Charesterictic And Management Strategies, Gomal Journal Of Medical Sciences Jan- Jun 2005, Vol 3 No 1.

. McDonald AP, Howard RJ: Pyogenic liver abscess. World J Surg 1980; 4:369-380.

. Alobaidi M, Shirkhoda A: Benign focal liver lesions: Discrimination from malignant mimickers. Curr Probl Diagn Radiol 2004; 33:239-253.

. Jeffrey Jr RB, Tolentino CS, Chang FC, et al: CT of small pyogenic hepatic abscesses: The cluster sign. AJR Am J Roentgenol 1988; 151:487-489.

. Huang SF, Ko CW, Chang CS, et al: Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor. Hepatogastroenterology 2003; 50:1115-1118.

. A. H. Mohsen, S.T. Green, R.C. Read and M.W. Mckendrick, Liver abscess in adults: ten experience in UK centre, Q J Med 2002; 95:797-802.

. Aphorisms, 45 Sect. 7,(IN) Adams –The Genuine Works of Hippocrates, Williams and Wilkins Co,1959.

. Arshad Zafar And Sajjad Ahmad , Department Of Surgery, Ayub Medical College And Surgicak ‘B’ Unit, Ayub Teaching Hospital, Abbotabad, Amoebic Liver Abscess Versus Conservative Treatment, J Ayub Med Coll Abotabad 2002; 14 (1)Pp10-12.




DOI: http://dx.doi.org/10.7439/ijbar.v8i5.3997

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