Percutaneous Drainage may not be Necessary in a Significant Subset of Patients with Complicated Liver Abscess

Abstract

Background and Aims: Clinical outcomes of liver abscess are changing, even in South Asia, where parasitic infections are common. We wanted to capture this emerging spectrum in ‘‘real life’’ through assessment of clinical features, management strategies, and outcomes of a cohort of treated liver abscess patients at a single center. Methods: In this retrospective study of patients admitted to a referral institution between February 2010 and June 2014, patients with liver abscess, who had received prior treatment in another hospital and then been referred for complicated illness, were studied; their demographics, presentations, evolution, and outcomes were analyzed. Results: A total of 154 patients [males 109, 70.78%), mean age 43.71 16.49 years] were included in this study. Alcohol was the commonest (n = 36, 23.38%) predisposing factor, followed by biliary obstruction (n = 32, 20.78%) and diabetes (n = 17, 11.04%). The most common presenting features were fever, pain abdomen, and jaundice [143 (92.86%), 133 (86.36%) and 32 (20.78%) respectively]. Majority of patients (90, 58.44%) had solitary liver abscess, right lobe being commonest location (94, 61.04%). Median abscess volume was 180 mL (7–1524 mL); abscess rupture occurred in 21 (13.64%) cases, most commonly to subdiaphragmatic location (12/21). Overall, 97 (63%) patients required abscess drainage [single time aspiration 15 (15.46%), percutaneous indwelling catheter in 80 (82.47%), and surgical drainage in 2 (2.06%)]. Patients who required percutaneous drainage were mostly males, had higher abscess volumes, and were more frequently alcohol users and diabetics (data provided in table). Six (3.9%) of the patients died during study period. Higher bilirubin level, shortness of breath, higher volume of abscess, and requirement of surgery were more frequent in non-survivors. Conclusion: While large abscess, alcoholism, and diabetes were associated with increased need for catheter drainage; 37% can be treated by drug therapy alone. Careful selection of subjects for drainagemight avoid premature mortality in this benign condition.