Etiological, Clinical and Radiological Profile of Suppurative Lesions in Solid Abdominal Visceras

Abstract

Purpose: The profile of abscess is changing over last few decades in the developing world. A few decades earlier the liver abscess in our country was invariably amoebic in nature, however, in recent times the pyogenic and mycotic abscess are being recorded with increasing frequency. This study aims to evaluate the etiological, clinical and radiological profile of suppurative lesions in intraperitoneal solid visceral organ like liver and spleen in our tertiary health care centre in North India. Methods: A total of 35 patients with intrabdominal abscess were prospectively evaluated over a period of one year in the Department of Gastroenterology, IMS, BHU, Varanasi (India). They were studied to detail clinical, hematological, biochemical, microbiological and radiological examination. Few special investigations like HIV testing, blood culture and ELISA for E. histolytica antibody were also carried out in our study. Results: Of the 35 cases, 30 had liver abscess and 5 splenic abscesses. There were significant changing trend on the incidence of amoebic abscess (70%) and pyogenic abscess (30%). Majority of patients with amoebic abscess presented a decade earlier than pyogenic abscess group. Anemia, moderate polymorphonuclear leukocytosis, elevated serum bilirubin, increased serum alkaline phosphatase, increased SGOT, increased SGPT, hypoalbuminemia were significantly observed in our study group. Most frequently isolated organism was Klebsiella pneumonia (10%) followed by E. coli (6.6%) and Staph aureus (3.3%). Amoebic abscess were mostly solitary (size >7 cm), echofree wall and subcapsular. Males were the dominant group in both liver and splenic abscess. Conclusion: Profile of suppurative disease affecting solid abdominal viscera is changing. Two decades earlier it was invariably involved liver of amoebic nature. In this study two fifth of cases were due to pyogenic abscess in which gram negative organism were predominantly isolated, affecting liver (26%) and spleen (14%), HIV coinfection was an important accompaniant (40%) in splenic abscess and chronic alcohol is seen in amoebic liver abscess (76.1%).