Management of giant amoebic liver abscess with severe sepsis by open drainage: a study of 28 cases in 20 years

Abstract

Background: Presently large amoebic liver abscesses are treated by intravenous antibiotics coupled with less invasive procedure like pigtail drainage. Pigtail drainage may not be adequate enough to drain thick pus and solid necrotic component in good number of large amoebic liver abscesses. In these cases, with severe sepsis, open surgical drainage is a life saver and a game changer. Aim of this study was to determine whether in critically ill patient with large amoebic liver abscesses results in good clinical outcome, by open surgical drainage. Methods: Over a 20-year period, 28 patients with giant amoebic liver abscesses, in severe sepsis, were managed by, an up-front open surgical drainage. In this prospective study we tried to evaluate time to reversal of the toxic features of sepsis, recovery of hemodynamic stability, degree of morbidity and hospital stay. Results: In all 28 patients treated by open surgical drainage (OSD), there was certainly rapid reversal of toxic features of sepsis, decrease in leukocyte count and accelerated recovery of hemodynamic stability in all are cases Three patients had surgical site infection, which were managed accordingly. The average hospital stay was 12 days. No mortality occurred in our study. Conclusions: The results of our study show that for large amoebic liver abscesses with severe sepsis, OSD provides better clinical outcomes in terms of treatment success, rapid recovery, recovery of hemodynamic stability, less morbidity and no mortality.