Liver Abscesses in Tropics

Abstract

Liver abscess is a life-threatening condition and relatively common in tropics. It may be infected by bacteria, fungal, and/or parasitic microorganism. The various risk factors are described for this disease. Amebic abscess accounts for the majority of the cases. Most hepatic abscesses are mono-microbial; however, it may have poly-microbial infections also. Klebsiella pneumoniae has emerged as one of the commonest causes of liver abscesses in most of Asian countries, with high rates of complications. The classic triad of presentation is right upper quadrant abdominal pain, fevers/chills, and malaise. The metastatic infection is reported in approximately 10–45% patients. Imaging and biochemical tests are suggestive of liver abscess. Treatment of abscess includes multi-disciplinary team approach, involves surgery, interventional radiology, and infectious disease specialists. The goal of treatment includes drainage of the abscess and targeted antibiotics for the eradication of the pathogen involved. Percutaneous CT or USG-guided drainage of abscess can be done either with needle aspiration or by inserting a pigtail catheter. Surgery is reserved in patients presenting with rupture, peritonitis, anatomically difficult abscess, or refractory to medical treatment and having co-existing pathology requiring surgery. The role of percutaneous therapeutic aspiration guided by US or CT for uncomplicated amebic liver abscess remains controversial. The complications of liver abscesses are reported in 15.7%.