Abstract
Background and objectiveLiver abscesses are one of the common surgical diseases to be treated as an emergency in any tertiary care hospital in India. The formation of abscesses in the liver is still a major problem and associated with significant morbidity in developing countries. We come across all types of liver abscesses, such as amoebic (most common), pyogenic, mixed, and occasionally fungal. There have been several studies on the percutaneous modality of treatment for pyogenic liver abscesses. Most of the studies suggest that percutaneous catheter drainage (PCD) offers a better approach than aspirations for treating pyogenic liver abscesses. However, a few recent studies suggest that percutaneous aspiration leads to equally good results when compared to percutaneous drainage. In this study, we aimed to review the management of solitary large pyogenic liver abscesses and to assess the effectiveness of ultrasonography (USG)-guided aspiration in the procedure. MethodsA retrospective study was carried out at the Department of General Surgery of our institute. In this study, a total of 27 patients treated for solitary pyogenic liver abscess were included. All patients with a large liver abscess greater than 5 cm without the features of frank peritonitis were included. These patients were followed up regularly for six months.ResultsThe single-attempt USG-guided aspiration was successful in 70.3% of patients. Repeat USG-guided aspiration was performed in 18.5% of patients. In 7.4% of patients, a USG-guided percutaneous pigtail catheter was placed. And only 3.7% of cases required exploratory laparotomy. ConclusionBased on our findings, USG-guided aspiration is a fairly efficient method for treating a large solitary pyogenic abscess with acceptable results, shorter hospital stays, and minimal complications.
Highlights
Liver abscess is one of the common causes of admission to general surgery departments in India
A total of 45 patients were treated for pyogenic liver abscess, but 18 patients were excluded on the basis of the exclusion criteria
We reviewed the clinical records of the included patients to document the following features: (A) Demographic characteristics (B) Clinical features such as abdominal pain, fever, jaundice, nausea, and vomiting (C) Risk factors like chronic alcohol consumption and biliary diseases (D) The basis of the pyogenic liver abscess diagnosis (E) Further management (F) Indications for abscess aspiration (G) Hospital stay and its indications (H) Complications (I) Follow-up characteristics
Summary
Liver abscess is one of the common causes of admission to general surgery departments in India. The formation of abscesses in the liver is still a major medical condition with significant morbidity in developing countries. We encounter all types of liver abscesses in clinical practice, ranging from amoebic (most common) to pyogenic, mixed, and occasionally fungal. Biliary diseases increasingly started to turn into liver abscesses, either of an obstructive pathology or a malignant etiology [2-7]. Other causes such as bacterial endocarditis, sepsis, intravenous substance abuse, liver trauma, and gastrointestinal endoscopy are etiologically documented [3,8]. We come across all types of liver abscesses, such as amoebic (most common), pyogenic, mixed, and occasionally fungal. Most of the studies suggest that percutaneous catheter drainage (PCD) offers a better approach than aspirations for treating pyogenic liver abscesses. We aimed to review the management of solitary large pyogenic liver abscesses and to assess the effectiveness of ultrasonography (USG)-guided aspiration in the procedure
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