Management Of Amoebic Liver Abscess Research Articles

Amoebic liver abscess in an adult Nigerian: A case report

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA. Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations. Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment. Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.

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

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.

ROLE OF OPEN SURGICAL DRAINAGE OR ASPIRATION IN MANAGEMENT OF AMOEBIC LIVER ABSCESS

Background: Since Hippocrates time, liver abscesses have been recognised. Apart from postoperative care, advancements in diagnostic and therapeutic methods have greatly lowered the high mortality rate. The present study aimed to establish the role of open surgical drainage or aspiration in management of amoebic liver abscess. Methodology: The present prospective observational study involved 30 patients aged over 18 years of both sexes who were hospitalised to the department of general surgery with symptoms consistent with liver abscess and were confirmed with amoebic liver abscess. Following enrollment, a complete clinico-medical and admission history, as well as a thorough physical examination, were obtained. Routine serological testing in addition to abdominal and pelvic ultrasonography are performed. Additional CECT abdominal procedures were conducted. Results: Out of 30 enrolled patients, 70.00% were male, and 30.00% were female. Out of the 30 cases in this study, 5 patients who had percutaneous aspiration had many minor abscesses, and one patient with a solitary abscess required open surgery due to recurring liver abscess. Under antibiotic coverage, the majority of patients required USG-guided percutaneous aspiration or pigtail catheter drainage. Conclusion: Surgical drainage or aspiration are both equally effective in treating patients with amoebic liver abscesses.

Clinical profile and management of amoebic liver abscess: A prospective study of 100 cases

Clinical profile and management of amoebic liver abscess: A prospective study of 100 cases

A critical role of ultrasonography in management of liver abscesses

Aims and objectives: to see the efficacy of ultrasonography in the management of amoebic liver abscess. We assessed whether patient required surgery or can be managed with drainage procedure on ultrasonography basis.Materials and Methods: This is a prospective study done from July 2014 to May 2015, in a medical college in remote area. A total of 88 patients diagnosed with liver abscess were included in the study for ultrasound-guided percutaneous aspiration or pigtail drainage management. All patients had been treated with antibiotics or antimicrobials for at least 2 weeks if treated conservatively and were still being continued for another 6 weeks.Results: A total of 88 patients with liver abscess were successfully treated, consisting 79 males and 9 female. The age ranged from 18 to 82 years with a mean of 43.6 years. A total number of 76 (86.36%) cases undergone percutaneous catheter drainage and 12 (13.6%) underwent needle aspiration. A total of 73 (82.95%) patients had single large abscess, while 8 (9%) had two and 7 (7.9%) had multiple abscesses. The abscesses were commonly located on the right lobe of liver. The Pigtail catheters of sizes 10 F to 18 F was introduced either directly under the guidance of the guide wire with safety precautions. The volume of pus aspirated averaged from 70 - 1200 ml, while the period of catheter drainage ranged from 7 to 24 days with the follow up on ultrasonography.Conclusion: This study shows a success rate of ultrasonography almost 98 % by avoiding unnecessary surgical intervention. It was confirmed that needle aspiration in small abscesses and catheter drainage in large abscesses offers the safest and best modality.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.258-262

Outcomes of a conservative approach to management in amoebic liver abscess.

Context:Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases.Aims:To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure.Settings and Design:A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011–2014) in India.Materials and Methods:Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM).Results:Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67%) patients were managed conservatively, while 11 (18.33%) patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P < 0.001) and volume (399.73 ± 244.46 vs. 138.34 ± 117.85 ml, P < 0.001) compared to those who did not need it. Patients that required intervention had a longer length of hospital stay (7.1 ± 2.4 vs. 4.8 ± 0.9 days, P < 0.001). On post hoc analysis, a maximum diameter of >7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA.Conclusions:A conservative approach is effective in the management of ALA for a majority of patients. Failure of conservative management was predicted by the size of the abscess (maximum diameter >7.7 cm). Even in the cases of failure, a gradual step-up with interventions was found to be safe and effective.

Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case

Abstract Background Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. Clinical case A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica . On an abdominal computed tomography a 15 cm × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Conclusion Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity.

English

OBJECTIVE: The purpose of the study was to find out the role of ultrasonography in management of amoebic liver abscess. In this area, the simplest method for diagnosis and to determine the effectiveness of treatment proved by disappearance of symptoms and regression in the size of abscess cavity. METHODS: We studied prospectively 48cases of suspected liver abscesses admitted to our institute over 3years (February 2011 to February 2014). Daily follow up of patients was carried out in hospital for at least 10days. Patients were later followed up by ultrasound after discharge. RESULTS: We found the clinical features of the disease similar to those mentioned in essential text books of medicine, except that pain is not always epigastric while fever may be absent and hepatomegaly is not marked. Ultrasound is a simple, cheap diagnostic test, which is available. Metronidazole is an effective treatment and five of the patients required invasive method for diagnosis or treatment. CONCLUSION: Amoebic liver abscess if untreated is a serious disease. We concluded that recognizing the disease clinically and proving it by ultrasound is the main method for diagnostic confirmation.

English

This prospective study was carried out on 41 patients with clinically and ultrasonographically confirmed amoebic liver abscess (ALA). All patients were evaluated clinically and by ultrasound on admission and day 15 and subsequently after 3 and 6 months. The majorities were young or middle aged males (65.85%) belonging to the lower socio-economic group. 70.73% gave history of alcohol consumption of locally fermented brands. The common clinical manifestations were right upper quadrant pain (92%). None of the liver function tests were diagnostic though alkaline phosphatase was elevated in 70.73% of patients. Ultrasonography was useful in diagnosis and guiding needle aspiration. The size of the abscesses varied from 2cm to 15cm in diameter. Five (12.19%) patients underwent ultrasound guided needle aspiration, required surgical drainage and the rest required antiamoebic drugs alone. Initial response was better in aspirated group but resolution of abscess (by ultrasound) after 6 months was similar. There were no complications of the procedure and no deaths. Needle aspiration combined with chemotherapy represents a successful therapeutic approach in the management of ALA. Despite successful therapy, 10 of our 41 patients had residual abscess cavity on ultrasound examination even after 6 months

Amoebic liver abscess: The Evolving Concept Of Management

Background Amoebic liver abscess (ALA) affects mainly rural, male population in endemic zone. Ultrasound guided aspiration and other surgical intervention is still a wide practice by treating personnel in all cases of ALA. Perhaps this approach further aggravates the suffering. So, aim was to evaluate the treatment protocol for ALA in order to have some guidelines in the management of ALA at our place. Methods and material 86 confirmed cases of ALA were treated according to the formulated protocol. Follow up was done and analysis was carried out. Results 82% cases were treated by drug therapy only. In ALA of < 500ml size, success rate of non invasive management was 98.1%. Conclusion 80% cases may be treated by medical treatment. Adjunct Surgical intervention required in a very few complicated cases. Percutaneous catheter drainage is a viable option in drug resistant cases.

Amoebic liver abscess--results of a conservative management policy.

To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. A prospective study carried out over a 1-year period. Inpatients and outpatients in a tertiary referral institution. Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours. Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.

Abcès amibien du foie. Analyse de 20 observations et proposition d'un algorithme thérapeutique

Purpose. – The management of amoebic liver abscess includes antiamoebic drugs combined or not with percutaneous puncture or surgical drainage. This study was to suggest a decision tree for the therapeutic approach of such feature. Methods. – We report a retrospective analysis of 20 imported cases with amoebic liver abscesses admitted at the Department of Tropical Diseases during 1995–1999 at the Bordeaux University Hospital Centre, France, and a review of the literature. Results. – The twenty patients were 14 males and 6 females, mainly 20 to 40 years old. The clinical presentation was mainly accounting a painful liver enlargement with hyperthermia. The echographic picture was mostly represented by a unique liver element located at the liver right lobe. They were numerous in an HIV infected patient. Thirteen patients have been treated using a medical therapeutic approach. A percutaneous puncture has been necessary for 4 cases. A percutaneous drainage has been realised for two patients as regard to the persistence of the hepatalgia occurrence. A surgical drainage has been experienced by two patients after a lack of efficacyof a percutaneous drainage, after rupture of an abscess treated medically, respectively. A review of the literature and the analysis of the 20 cases history have been used to determine a therapeutic algorithm. Conclusion. – The occurrence of immediate complications at onset must indicate a first line surgical drainage procedure. Beside this situation, risk factors for rupture must be assessed (high size abscess, pejorative localization), as well as poor prognosis feature (liver failure, bacteraemia). If no pejorative condition occurs, a first-line exclusive medical approach can be undertaken with a clinical efficacy evaluation at H72. Otherwise, the indication of the percutaneous drainage must be discussed.

Experiences with grey scale ultrasonography in hepatic amoebiasis

Ultrasound examination was conducted in 151 proven cases of amoebic liver abscess. In the majority of patients the lesion was solitary but 25% of patients had multiple lesions; 17% of all the abscesses were in the left lobe of the liver. Most abscesses had no, or very few internal echoes and these were either of the same density as the normal liver (15%) or less dense (84%). In all cases there were relatively fewer echoes in the lesion. Abscesses in critical areas were accurately located especially in relation to the pericardium. Other liver lesions such as hepatoma which may enter into the clinical diagnosis can be recognised. Ultrasound has particular value in accurate localisation of the lesion for aspiration, demonstration of unsuspected multiple abscesses and size estimation in serial studies of the patient under treatment. The diagnostic errors were mainly due to initial inexperience and demonstrated some of the diagnostic pitfalls. It is concluded that the introduction of this technique has proved to be of considerable value in the diagnosis and management of amoebic liver abscess in our area, where the disease is still a major clinical entity. If diagnosed early and treated adequately the condition has an excellent prognosis.