Ruptured Liver Abscess Research Articles

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking. Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause. Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1). Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.

Study of liver abscess in pediatrics patients in tertiary health care institute

liver abscess is mostly occurring due to the infection of bacteria, parasite like amoeba. The incidence of amoebic liver abscess varies all over the world and most of cases found in developing countries remain unreported. study of liver abscess in pediatric patients in tertiary health care institute. This was a prospective study, carried out in 64 at our tertiary care center, J K Lon Hospital, SMS Medical College, Jaipur from May 2022 to April 2023. We collect all data related to patients like demography, clinical features, laboratory finding, and imaging records and recorded on a pre-decided proforma. There were 64 patients (36 male, 56.25% and 28 females, 43.75%), The male to female ratio was 1.25:1. The mean age of presentation was 7.5 years. The common presenting symptom was anorexia in 55 (85.93%) cases. Most common symptom was abdominal pain in 60 (93.75%) cases, fever 58 (90.625%), and vomiting in 40 (62.5%%) cases. Diarrhoea was present in 5 patients. Anemia was most common clinical sign in present in 40 (62.5%) patients, weight loss 38 (59.37%). Respiratory distress was present in 4 (6.25%) due to pleural effusion and peritonitis cases. Jaundice was present in 5 (7.81%) . 5 case [7.81%] of patients had raised bilirubin and 28 patients [43.75%] had raised alkaline phosphatase levels. Raised SGOT and SGPT was 43.75 %. 34 patients of Amoebic liver abscess and 30 of Pyogenic liver abscess. 53.12% (34 cases) patients had amoebic liver abscess in the right lobe. less than 50 cc size of abscess was present in 24 patients (37.5%) cases. Most of the patients have cavity size 50-150cc. more than 200cc cavity found only in 10 cases. Average cavity size is 166cc. peritoneal ruptured liver abscess in 2 cases [3.12%%] had features of peritonitis, pleural effusion in 2 cases with complain of respiratory difficulties. Conservative medical management was done in 2 patients, USG guided needle aspiration 20 patients and 40 patients underwent pigtail catheter insertion. 12 fr pigtail catheter insertion was done in 30 patients and 10 patients underwent double pigtail catheter insertion. Exploration and drainage of liver abscess was done in 2 patients. In present study, mean hospital stay was 10.28 days. Hospital stays ranges from 5 to 17 days. Most of the patients stays 5 to 10 days [56.25%]. all amoebic liver abscesses were sterile. Most commonly found organism on pus culture was Staphylococcus in 25% cases followed by E. coli in 21.87% cases in pyogenic liver abscesses. from this study we found that ultrasonography is the standard modality for diagnostic and therapeutic management as well as for drainage and follow up. We also found that USG guided pigtail catheter drainage is a superior therapeutic approach than needle aspiration for large liver abscess, and abscess cavity resolves better in case of pigtail catheter drainage. We also concluded that ruptured liver abscess can also be managed with two pig tail catheter insertion.

A Comprehensive Study on Ruptured Liver Abscess in a Tertiary Care Center.

Background Bacteria and parasites cause liver abscesses (LAs), with the unusual but fatal consequence of ruptured LA. Along with the clinical signs of icterus, right upper quadrant pain, and a history of loose stools, patients present with non-specific symptoms such as fever, nausea, and generalized weakness. Consistent findings include male sex prevalence and frequent alcohol consumption. Leukocytosis, abnormal liver function, and an increased international normalized ratio have been identified by biochemical analysis; however, these findings are not specific to a ruptured LA diagnosis, and imaging is necessary to reach a definitive diagnosis. Ultrasonography usually confirms the diagnosis, and computed tomography is required in certain situations. In confined ruptures, percutaneous drainage combined with antibiotic therapy is typically the initial treatment course. Generally reserved for non-responders or moribund patients with delayed presentation, an open surgical approach may involve simple draining of a ruptured abscess or ileocecal resection, or right hemicolectomy in cases of large bowel perforations, both of which increase patient morbidity. A definite guide to management is still missing in the literature. In this article, we have discussed and correlated with data the predictors of surgery and preoperative predictors of perforation. Materials and methods This retrospective study was performed at Safdarjung Hospital, New Delhi, between January 2022 and December 2023. The study included 115 patients diagnosed with ruptured LA by ultrasound. Medical records were analyzed, and various parameters of the illness, clinical features, hematological and biochemical profiles, ultrasound features, and therapeutic measures were noted and assessed. Results Of the 115 patients, 88% (n = 101) were male. The most common symptoms were abdominal pain (114 patients) and right upper abdominal tenderness (107 patients).Fifty-two patients were treated with percutaneous drainage, and 42 underwent laparotomy. Intercostal drainage (ICD) tubes were placed in 19 patients. Sixteen patients had large bowel perforations. Twenty-three patients died (20%), including 17 patients who underwent laparotomy and nine patients who had large bowel perforation (39.1% associated with overall mortality, 52.9% associated with mortality in laparotomy). One patient with percutaneous drainage and a right ICD tube died in the intensive care unit. Four patients died before intervention. Significant associations were noted between perforation and mortality in patients who underwent surgical drainage. Loose motions, alcohol and smoking consumption, and deranged creatinine and albumin levels were found to have a significant association with surgical drainage. Conclusion The study found that a ruptured liver abscess (LA)may require surgery to drain the collection or repair the pathological bowel, which increases the morbidity, but it is a lifesaving procedure over percutaneous catheter drainage. The study also identified factors associated with a higher risk of death, such as a history of loose stools and low blood albumin levels.

An unusual case of tubercular liver abscess presenting as pericardial effusion

Tropical nations like India frequently have liver abscess. They are typically amoebic or pyogenic abscesses. It can sporadically be a sign of hepatic tuberculosis (TB). Hepatic tuberculosis should be suspected in cases where the patient doesn’t present with typical complaints of pyogenic/amoebic abscess without response to commonly used antibiotics. Pyogenic/amoebic liver abscesses show the rare complication of rupture into the pericardium, especially if the abscess is left sided. However, a tubercular pericardial effusion presenting with rupture into the pericardium has rarely been reported. We present to you a case of tubercular pericardial effusion in a known diabetic patient secondary to ruptured liver abscess presenting to the emergency department with chief complaints of breathlessness, chest pain and bilateral pedal edema.

鈍的腹部外傷を契機に肝膿瘍破裂を来した侵襲性肝膿瘍症候群の1例(Invasive liver abscess syndrome associated with ruptured liver abscess secondary to blunt abdominal trauma: a case report)

要旨 鈍的腹部外傷を契機に肝膿瘍破裂を来した侵襲性肝膿瘍症候群の症例を経験した。症例は70歳代の男性で運転中の一過性意識障害により，事故を起こした。CT検査で肝S5深部からS6に造影剤血管外漏出像を伴う日本外傷学会肝損傷分類IIIb型の肝損傷と診断した。緊急動脈塞栓術を施行し止血を得たが，血液検査でCRP 20.68mg/dLと高値であった。第2病日に体温38.5℃の発熱を認め，感染症の合併を疑い，各種培養を採取し抗菌薬を開始した。第4病日に過粘稠性Klebsiella pneumoniaeが検出され，第5病日にCT検査を再検したところ肝S6に肝膿瘍を認めた。受傷後から右季肋部痛が出現し，後方視的に検討すると来院時のCT画像で肝膿瘍破裂の所見を認めたことから，肝膿瘍による敗血症が先行し鈍的腹部外傷を契機に肝膿瘍破裂を来したと判断した。第9病日に経皮的ドレナージ，第14病日に腹腔鏡下洗浄ドレナージを施行した。第23病日にCRP 17.0mg/dLと再上昇を認め，CT検査を再検したところ，胸腰椎移行部に傍椎体膿瘍を認め，侵襲性肝膿瘍症候群による転移性病変と考えた。肝膿瘍破裂は早期ドレナージが重要であり，鈍的肝損傷の診療において，炎症反応高値と非典型的な画像所見を認めた際には肝膿瘍破裂を疑い治療を進める必要がある。

A Cross Sectional Study to Assess Clinical Profile of Patients with Liver Abscess in Tertiary Care Centre at Central Rajasthan

Introduction: A liver abscess is infective disease of liver parenchyma having collection of purulent material that can develop as a consequence of injury to the hepatic tissue or via portal vein from any source of infection within abdominal cavity. Mostly liver abscess are either due to amoebic infection or pyogenic bacterial infection but in some cases, etiologies like fungal, tubercular or sometimes mixed infections is also seen. Material and Methods: This present cross-sectional study was carried out by recruiting 137 patients diagnosed of having liver abscess at medical OPD at JLN Hospital, Ajmer during the year December 2019 – June 2021. All the patients with confirmed liver abscess were included in this study. Patients age below 18 years, critically ill patient (Including patients having ruptured liver abscess at the time of presentation and requiring surgical intervention), Pregnancy and GI Malignancy Results: 137 liver abscess patients were studied and males from lower middle class with a mean age of 38.41±8.81 years were more affected. Biochemical, serological, stool test, radiological and Mantoux test were performed and the mean alkaline phosphatase, GGT, SGOT, SGPT, bilirubin (Total/Direct/Indirect) and PT/INR were found to be raised. Discussion: Right lobe of liver abscess was solitary. Right side pleural effusion followed by elevation of right hemidiaphragm was the abnormality diagnosed through X-ray. The survival rate was higher either with percutaneous needle drainage or pigtail drainage. E.coli followed by group A beta hemolytic streptococcus, tubercular and fungal etiologies were the most commonly isolated bacteria on pus culture. Blood, urine and stool culture showed positive cultures and some patients with tubercular liver abscess had mantoux test and sputum AFB positive. Conclusion: Liver abscess is most commonly seen in male from lower middle class mostly in 4th decade of life who are non-vegetarian and alcoholic. As non-vegetarian diet and alcoholism were found to be the most common risk factors, it is suggestible to avoid/restrict their intake to avoid liver abscess. Keywords: Liver abscess, usg, Entamoeba histolytica

Ruptured Liver Abscess in Children: A Rare Case Presentation

Liver abscess is a common condition in tropical countries and is associated with significant morbidity and mortality. Traditionally, there are two major classifications of hepatic abscess; pyogenic and amoebic. There are various complications associated with hepatic abscesses, of which, rupture of the abscess is the most common. Intraperitoneal rupture of liver abscess is a rare but potentially fatal disease. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. Improving imaging techniques have aided the CLInicians in the diagnosis of hepatic abscesses and have subsequently become important treatment tools, the demographics of the hepatic abscess have changed. Though open surgery still remains the most commonly used management modality, with the advent of minimally invasive surgery. Thus, multiple management options are available today and a ruptured liver abscess is preventable and manageable. No specific guidelines are available for choosing the modality of treatment. Thus, this article's purpose is to report a case of a patient that presented with acute abdomen at the emergency caused by a rupture liver abscess. A 7-year-old male child presented to the Emergency Department due to severe abdominal pain during the last 7 days. The pain was located in the RHC, associated with constipation and three to four episodes of vomiting. On physical examination, generalized abdominal tenderness was present without any guarding or rigidity, and no abdominal lump was palpable. There were no signs of peritonitis. Blood tests including complete blood count, serum electrolytes, bilirubin, and liver and kidney function tests were performed which were unremarkable and showed no other abnormalities. Prothrombin time, partial thromboplastin time and INR (International Normalized Ratio) were normal. In our case in diagnostic laparoscopy after initial abdomen exploration around 200cc purulent fluid-filled peritoneal cavity was noted and a ruptured liver abscess diagnosis was confirmed so diagnostic laparoscopy converted to exploratory laparotomy. Peritoneal lavage was given with approx 1500cc warm saline. and metronidazole wash is also given. after clearing all toxic fluid and. All abdominal organs were examined and layer-wise closing was done. The total operative time was 120 minutes and our patient’s postoperative period was uneventful. He was discharged on seven postoperative days.

A CASE REPORT ON HEPATOGASTRIC FISTULA IN A CASE OF LIVER ABSCESS

Liver abscess is a common cause of febrile illness in India. It usually presents with fever and right upper quadrant abdominal pain. Upper gastrointestinal bleeding is not a commonly described clinical presentation of liver abscess. In liver abscess, upper gastrointestinal bleeding would usually be attributed to nonsteroidal anti-inflammatory druginduced esophagitis, erosive mucosal disease, or duodenal or gastric ulcer, as would be expected in any febrile illness. I present a case report of a patient who presented with febrile illness and upper gastrointestinal bleed due to a ruptured liver abscess perforating into the stomach.

STUDY OF ETIOLOGY OF LIVER ABSCESS AND IT'S DIFFERENT WAYS OF MANAGEMENT

Background: Liver abscess are cystic, space occupying lesion within liver parenchyma. It has become one of the most common disease with more prevalence in underdeveloped and developing countries. Pyogenic liver abscess more common in western world while amoebic liver abscess are more common in underdeveloped countries and people living with lower socio-economic conditions. Liver abscess, undiagnosed and untreated, has a very high mortality rate. With early diagnosis and prompt institution of specic therapy, the prognosis is good and the mortality is very low. Surgical management was the mainstay for treating liver abscess earlier. However, USG guided percutaneous needle aspiration and percutaneous drainage procedure shown a favorable outcome with less average length of stay in hospital. In this study we aimed to study etiology of liver abscess and its different ways of management. To study the etiology of liver abscess Aim: Materials And Methods: and its different ways of management. This is a prospective, observational study was conducted in GSVM Medical College, LLR & Associated Hospitals, Kanpur (UP).Study was done on 100 patients with different types of liver abscess. Patient with ruptured liver abscess were not included. Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); relieving of symptoms and length of stay in hospital. Results: Out of 100 patients majority of patients were in the age range of 31-45 (56.0%) followed by 46-60 (22.0%) with mean age of 40.74±10.53 years. Most of the cases were males (98%), and females (2.0%). Majority of patients were with lower socioeconomic status (96%). Most of the patient having amoebic liver abscess (66%) with positive ELISA for antibodies, while 34 % of patient having pyogenic liver abscess with 10% having bacterial growth on culture examination having E.coli . 84% of cases having liver abscess in right lobe and were single (66.0%). On the basis of their personal history, comorbidities and clinical features, 14.05 were diabetic, 44.0% were alcoholic, 98% were having fever with 60% cases have chills and rigor and 100% having pain in right upper quadrant. Majority of cases undergone pigt Conclusion: ail treatment were pyogenic (76.4%) and majority of amoebic abscess were treated with aspiration (72.7%) and difference was found statistically signicant with p value of 0.001. Reduction in size of abscess cavity was observed in all the cases but recurrence was higher in conservative treatment (p=0.007) and length of stay was higher in pigtail (p<0.001).

Tuberculosis Presenting as Ruptured Liver Abscess and Inferior Vena Cava Thrombosis in a Pediatric Patient

Tuberculosis Presenting as Ruptured Liver Abscess and Inferior Vena Cava Thrombosis in a Pediatric Patient

Liver abscess rupture into the chest wall with multi-localized pleural effusion

ABSTRACT Amoebic liver abscess (ALA) is a serious but readily treatable form of hepatic infection. It is a tropical disease with a wide spectrum of clinical manifestations. Although most amoebiasis cases are asymptomatic, dysentery and invasive extraintestinal diseases can occur. ALA is the most common manifestation of invasive amoebiasis; however, other organs can also be involved, including the pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. In developed countries, amoebiasis primarily affects those who have traveled to or migrated from endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals. Here, we report a case of a patient with extraintestinal amoebic lesions complicated by chest rupture. A 22yearold male from India presented to the emergency department with a cough, fever, weight loss, hemoptysis, chest pain, and diarrhea. He was diagnosed with a liver abscess that ruptured into the chest with multiloculated pleural effusion.

INFLAMMATORY PSEUDOTUMOR OF THE LIVER: 3 CASE REPORT AND LITERATURE REVIEW

Inflammatory pseudotumor of the liver (IPTL) is a rare benign lesion characterizedby chronic infiltration of inflammotory cells and an areas of fibrosis that sometimesmimics a malignant lesion, first reported by Pack and Baker in 1953. The etiologyand pathogy still remain unknown. Clinical and laboratory features are not specific.The treatment attitude is still controversial. We report 3 cases of IPTL who weretreated surgically with preoperative diagnosis of ruptured liver abscess or a malignantliver tumor. The postoperative patient was safe and the pathological results wereinflammotory pseudotumor of the liver. Conclusion: IPTL is a benign lesion thatcan be confused with other diagnoses of the liver. The treatment of choice is stillsurgical resection, and this is especially true for patients with severe symptomsor an indeterminate diagnosis.

Outcome of rupture liver abscess in tertiary care center

Background: Liver abscess is common clinical condition encountered in outpatient and emergency setting however; rupture of it can lead to higher morbidity and mortality of patients. Despite different and easily accessible modalities are available to diagnose the condition early, still ruptured liver abscess presents with a common cause of acute abdomen in surgical emergency.Methods: This was a retrospective study carried in Sarojini Naidu Medical College, Agra, between 2019 and 2021. All patients with ruptured liver abscess (ultrasound diagnosed) were included in this study, and those patients having other causes of peritonitis were excluded.Results: Out of the fourty patients assessed, all patients were male (100%). The most affected age group was 31-40 years (50%) followed by 41-50 years (30%). Right hypochondrium pain was the most common presenting complaint. 80% have history of chronic alcohol intake. Twenty patients (50%) had presented with signs of toxemia. Only right lobe of the liver was affected the most in 28 patients (70%). Escherichia coli was the most common organism isolated in our study in 21patients (52.5%). A total of 16 patients (40%) had diabetes in our study and total of 7 (17.5%) patients had mortality in our study.Conclusions: Ruptured liver abscess can be diagnosed in emergency setting and is preventable if early intervention is done. It carries high morbidity and mortality so early diagnosis and prompt treatment can reduce the risk of it.

P181 Mucor in the land of the liver: a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction and ObjectivesMucormycosis is a rare, highly lethal opportunistic fungal infection affecting immune-compromised patients. It accounts for about 2% of invasive fungal infections occurring within 1 year after solid organ transplantation. Among renal recipients, Rhinocerebral is the commonest manifestation and Rhizopus species is the most frequent pathogen.The objectives are:To report a case of Hepatic mucormycosis in a renal transplant recipient.To resolve the dilemma in identification of Mucorale species detected on microscopy but culture negative.MethodA 29-year-old male patient was admitted with severe abdominal pain on day 28 post-live related renal transplantation. Patient was hypertensive, on oral steroids for idiopathic thrombocytopenic purpura, chronic kidney disease with venous thromboembolism-presumed chronic interstitial nephritis, and maintained on hemodialysis for the last 1 year. Post-transplant he was on triple immunosuppressants.Initial ultrasound of abdomen and transplant doppler were normal. CT of abdomen in view of worsening hypotension and non-resolving abdominal pain, revealed hepatomegaly with multiple discrete, coalescing hypodense areas in both lobes of liver with minimal subcapsular extension. Initial cultures included interventional radiology-guided liver aspirate and blood culture. Patient was started on antibiotics and antifungals. Patient continued to deteriorate and a repeat abdominal CT revealed an increase in liver size and rupture of liver abscess. Sample collected on pigtail catheter insertion was also sent for culture.ResultsThe pus aspirate was received for bacterial and fungal culture. Aerobic bacterial culture yielded Klebsiella species. Examination with KOH Calcofluor revealed broad aseptate fungal hyphae. However, fungal culture did not yield any growth. Pain resistant (PDR) Klebsiella species was isolated from blood culture. Pigtail catheter sample also yielded the same. Aseptate fungal hyphae were observed in the pigtail catheter sample also. The team decided on conservative management and patient was started on intravenous amphotericin B deoxycholate(50 mg/day), tigecycline, and meropenem. Immunosuppressants were withheld. The clinical course worsened and the patient succumbed to illness after 18 days of antifungal therapy. The pus sample was then sent to the referral center PGIMER for PCR and sequencing where it was identified as Lichtheimia species.ConclusionMucormycosis is an increasingly emerging invasive fungal infection especially in immune-compromised patients, including solid organ transplant recipients. Though uncommon it is frequently a fatal mycosis in transplant patients. Hepatic mucormycosis in renal transplant recipients has been reported in three patients so far. None are due to Lichtheimia species. The diagnosis of hepatic mucormycosis was confirmed as microscopy was positive in two successive samples. Our patient also had bacteremia with PDR Klebsiella.Diagnosis is challenging and often delayed, as the clinical presentation is non-specific. Although mucormycosis in a renal transplant recipient is rare, a high index of suspicion and critical microscopic examination is warranted for early initiation of specific therapy which includes liposomal amphotericin B and surgery. Often cultures yield no growth and gene sequencing proves to be efficient and time-saving. This probably is the way ahead, especially for culture-negative samples to establish the etiological diagnosis.

Analysis of ruptured amoebic liver abscess

Introduction: Amoebic liver abscess (ALA) is the most commonly seen extra intestinal manifestation of Entamoeba infection.[1] Out of which, a rare complication of amoebic liver abscess is rupture of liver abscess. We report 43 cases of ruptured amoebic liver abscess coming with acute abdomen which were operated at Department of Surgery, Dhiraj general hospital, Vadodara from January 2020 to December 2021. Surgical treatment in these cases should be carried out in a timely fashion prior to the presentation of systemic repercussions or death. result: Out of all patients, 37 patients were male and 6 were female and 37 patients were chronic alcoholic. The mean age was 47 years. At presentation, most cases had clinical signs of generalized peritonitis. Ultrasonography for collection in peritoneal cavity showed moderate free fluid with internal echoes suggestive of pyoperitoneum. Out of which 09 patients had free air under the diaphragm. All 43 patients underwent resuscitation and then shifted for surgery. All underwent exploratory laparotomy for ruptured liver abscess. Intraoperatively, 05 patients had a single abscess in the right lobe, 06 had abscess in both lobes of liver and 33 had multiple abscesses in right lobe.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

A rare presentation of ruptured amoebic liver abscess with caecal perforation - a case series

A rare complication of simultaneous rupture of liver abscess with caecal perforation occurs mainly in malnourished patients and carries a high mortality rate. In invasive amoebiasis, the trophozoites penetrate the intestinal mucosal layer causing amoebic colitis which is carried along the portal circulation to produce liver abscess that is more prone to rupture in cases of immunocompromised status. Here we report 4 cases of ruptured liver abscess associated with caecal gangrene which were operated at our institute. All 4 patients were male who were chronic alcoholics and presented with ruptured amoebic liver abscess and simultaneous perforation of caecum that was identified on exploratory laparotomy. The different approaches to surgical management of these patients is discussed, wherein early identification and timely intervention remain as mainstay of treatment in all cases.

A Case of Ruptured Liver Abscess Refractory to Conservative Treatment That Was Successfully Treated by Hepatic Resection

A Case of Ruptured Liver Abscess Refractory to Conservative Treatment That Was Successfully Treated by Hepatic Resection

Hepatic-portal venous gas embolism due to liver abscess rupture

Hepatic-portal venous gas embolism due to liver abscess rupture