Study of Different Modalities of Management in Patients with Liver Abscess in a Tertiary Care Centre
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 1
Abstract
Introduction: Management of liver abscess was exclusively surgical in the past. Modern treatment has shifted toward broad-spectrum antibiotics and imaging-guided percutaneous needle aspiration or percutaneous catheter drainage. This retrospective study has been carried out to evaluate etiology of liver abscess and compare effectiveness of different modalities of treatment. Methods: This is a retrospective observational study of patients of liver abscess treated during the period of March 1, 2014, to March 1, 2015, at New Civil Hospital, Surat. They were treated by different mode of intervention. All patients underwent clinical follow-up and monitoring during daily rounds until they were discharged from the hospital. Follow-up sonography was performed 24 h after intervention and repeated every 3 days in 1st week, and the size of the abscess was recorded. Criteria for successful treatment were clinical subsidence of infection and sonographic evidence of abscess resolution. Results: A total of 73 cases of liver abscess were studied at New Civil Hospital, Surat, during the period. It is more commonly seen in adult life with highest incidence in 3rd–5th decade. The most common presenting symptoms are pain and fever. Tenderness is present in most of patients, whereas signs of jaundice, ascites, and shock are rare. Liver abscess is seen frequently in alcoholic patients. Most of the patients with liver abscess are anemic and with elevated total white blood cell count and increased serum alkaline phosphate. <16% have abnormal chest X-ray with pleural effusion being the most common. Most often right lobe is involved in pyogenic liver abscess. Of 73 cases, 3 cases (4.1%) show at least one of the complications. Rupture of abscess occurred in 2 patients (2.71%) into pleural cavity who were treated by intercostal drainage and in 1 (1.36%) patient into peritoneal cavity treated with exploratory laparotomy with drainage of pyoperitoneum. Conclusion: Liver abscesses continue to be an important cause of morbidity and mortality in the tropical countries. Percutaneous drainage with systemic antibiotics has become the preferred treatment for the management of pyogenic liver abscesses. In contrast, for amebic abscesses, the primary mode of treatment is medical. Surgical drainage is now used only in cases which fail to respond to percutaneous drainage.
Authors and Affiliations
Jawansing Manza, Hardik Makwana, Mukesh Pancholi, Nimesh Verma
Keywords
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