Liver abscess-various modalities of treatment and its clinical outcome

Abstract

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. The primary mode of treatment of amoebic abscess is medical; however many cases may be refractory to medical therapy. In such patients with pyogenic liver abscesses, aspiration has been the traditional mode of treatment. In the present study of liver abscess of different etiology the following treatment modalities such as medical management, aspiration and percutaneous catheter drainage have been studied. Methods: The Present study was conducted in Bangalore Baptist hospital during the period from August 2010 to December 2012. All 70 patients with the diagnosis of liver abscess were included in the study. Detailed morphology of liver by radiology and ultrasound abdominal scan for abscess was examined. Routine blood and serological examinations to detect anti-amoebic antibodies by IHA were performed. After thorough examination patients were hospitalized and underwent with antibiotic therapy. Patients not responding to parenteral antibiotics therapy within 48-72 hours, were subjected to ultrasound guided aspiration if the abscess cavity was less than 5 cm in diameter and percutaneous catheter drainage for cavity more than 5 cm. Results: The age group of the study patients ranged from the 2-78 years and the incidence of sex ratio male:female was 10.6: 1. The incidence of alcohol consumption was 74% and it was more common in age group between 31 - 40 years. Solitary abscess was found in 59% and 41% of patients had multiple abscess. Serology for Entamoeba histolytica was positive in 88.6%. Commonest presentation was right upper quadrant pain and fever. Raised alkaline phosphatase was noted in 84.3 % of patients. Initially all patients were managed with antibiotics (ciprofloxacin and metronidazole). Patients who are not responding to antibiotics, aspiration was done in 15 patients with volume of pus 100 cc-200 cc and percutaneous catheter drainage was done in 27 patients with volume of pus >200 cc by using 18Fr Malecot’s catheter which found to have less incidence of blockage. Conclusions: In the present study abscess containing volume of pus 100-200 cc was treated with either conservative antibiotic treatment alone or aspiration of pus with antibiotics. Abscess containing volume of pus >200 cc was treated with percutaneous catheter drainage along with antibiotics. From the study, it was concluded that percutaneous needle aspiration and percutaneous catheter drainage are more effective than conservative medical management in treatment of liver abscess; however co-morbid conditions of patients and size of liver abscess also influence the outcome.