Management of Amoebic Liver Abscess: A hospital based prospective observational study

Abstract

Background: Approximately 400 million people worldwide are affected by amoebiasis and the most common extra-intestinal manifestation of this infection especially in developing countries is amoebic liver abscess. The protozoa Entamoeba histolytica, enters the portal venous system from the colon. Early and prompt diagnosis with immediate treatment leads to improved morbidity and mortality rates. Primary treatment of amoebic liver abscess is conservative, however in certain high risk cases for rupture, guided drainage or surgical exploration should not be delayed. Materials and methods: This was a hospital based prospective observational study conducted in the Department of Surgery, Hamdard Institute of Medical Sciences & Research, New Delhi. The study was conducted over a period of 02 years from March 2018 to March 2020. A total of 52 patients with diagnosis of amoebic liver abscess were included in the study. Follow up period was 06 months after discharge from the hospital. Data was analyzed and observed for various parameters including various modalities of management, morbidities and moralities. Results: A total of 52 patients (48 male and 04 female) were included in the study. A low prevalence of amoebic liver abscess was seen in the patients below 10 years of age. Majority of our patients belong to lower middle class (42.30%). Abdominal pain was the most common symptom reported (78.84%). Most commonly seen abnormalities in laboratory findings were deranged coagulation profile (71%), leukocytosis (65%), hypoalbuminemia (60%) and elevated alkaline phosphatase (52%). Right lobe was involved in 80 % patients and 94% patients had solitary abscess. Amoebic serology was positive in all patients. All patients were treated with Metronidazole 750mg (intravenous/oral) thrice daily for a period of 10-14 days. Out of 52 patients, 43 showed improvement after initial three days of therapy with metronidazole. Remaining 09 patients didn’t show improvement with metronidazole alone and hence were subjected to other treatment modalities. Conclusion: Amoebic Liver abscess is prevalent in developing countries particularly India owing to the poor sanitation and hygiene conditions. Most of the uncomplicated cases detected early can be managed medically while those developing complications may need intervention in the form of aspiration or pigtail insertions. Surgical exploration in the form of laparoscopy and laparotomy is reserved for selected cases of rupture and where ever possible laparoscopic drainage should be preferred. The key to preventing amoebic infections is mass sanitation awareness along with improving health education.