Solitary Liver Abscess Research Articles

A rare case report on neonatal complications from Nepal: solitary neonatal hepatic abscess.

We present the case of a patient who presented with one day of sudden abdominal distension and two episodes of projectile nonbilious vomiting. A solitary liver abscess was diagnosed using ultrasonography and contrast-enhanced computed tomography findings, and the patient was treated conservatively with parenteral broad-spectrum antibiotics. Following the completion of the antibiotic dose, an ultrasound of the abdomen reveals that the size of the liver abscess has decreased. Neonatal liver abscess is a rare clinical condition that causes significant morbidity and mortality in premature and term babies. In a neonate with potential risk factors, a high index of suspicion is required to make the diagnosis. Baseline tests, as well as computed tomography with or without contrast, aid in the definitive diagnosis of a hepatic abscess. For management, a multidisciplinary approach should be considered, including correction of the predisposing factor as well as appropriate medical and/or surgical intervention. Neonatal liver abscess is frequently overlooked due to its rarity. Thus, whenever a neonate exhibits the aforementioned clinical spectrum, it should be considered in the differential diagnosis, and a diagnostic workup and treatment should be initiated as soon as possible to avoid debilitating complications.

Analyse des différences cliniques et radiologiques entre abcès hépatiques amibiens et à pyogènes à partir d’une étude cas-témoin

IntroductionAmoebic liver abscess (ALA) is the fourth cause of mortality by parasitic infection. This study aimed to assess clinical, radiological and therapeutic characteristics of patients admitted for amoebic liver abscess compared to pyogenic abscess in a French digestive tertiary care-centre. Material and methodThe charts of patients hospitalized for a liver abscess between 2010 and 2020 were retrospectively assessed then separated in two groups: amoebic liver abscess and pyogenic liver abscess from portal underlying cause. Clinical and radiological data were collected for univariate comparison. ResultsTwenty-one patients were hospitalized during the time of the study for ALA, and 21 patients for pyogenic liver abscess with a portal mechanism. All patients hospitalized for ALA lived in and/or had travelled recently in an endemic area. In comparison with patients hospitalized for pyogenic abscess, patients admitted for ALA were younger (44years old vs. 63years old, P<0.001), had less comorbidities (5% vs. 43% of patients with at least one comorbidity, P<0.01), a longer median duration of symptoms (10days vs. 3days, P=0.015), abdominal pain (86% vs. 52%, P=0.019), and a slighter leucocytosis (9600G/L vs. 15,500G/L, P=0.041) were more frequent. On the abdominal tomodensitometry, density of ALA was higher (34 vs. 25 UH, P<0.01), associated with a focal intra-hepatic biliary dilatation and less often multiloculated. ConclusionWhile rare in western countries, amoebic liver abscess care should not be underestimated. The presence of a solitary liver abscess of intermediate density on computed tomography, occurring on a patient returning from an endemic zone should lead the physician to a possible diagnosis of ALA.

Complex Pyogenic Liver Abscess: Outcome of Open vs Laparoscopic Drainage

OBJECTIVES Our study aimed to evaluate the safety and efficacy of laparoscopic drainage as a management of complex pyogenic liver abscesses in comparison to open surgical drainage. METHODOLOGY The comparative research design was used to compare the outcomes, complications, perioperative morbidity, mortality, and potential recurrence of 60 patients with a complex pyogenic liver abscess who were hospitalized at the General Surgery Department of Hayatabad Medical Complex Peshawar and treated either laparoscopically or openly from January 2019 to December 2020. 30 patients had open drainage management, while 30 patients received laparoscopic drainage management. For all patients, pus was examined for culture sensitivity. Patients with a small, solitary and unilocular pyogenic liver abscess that improved with antibiotic therapy and or/and percutaneous drainage were excluded. Each patient had a thorough clinical evaluation, lab tests, ultrasound, computed tomography, or magnetic resonance imaging of the pelvis and abdomen. RESULTS All patients underwent abdominal ultrasonography &amp; sonographic diagnosis was made in 43(71.7%), followed by a computed tomography scan (CT) in 12(20%) &amp; magnetic resonance imaging (MRI) diagnosis was made in 5(8.3%) patients respectively. Diabetes mellitus was present in 15(25%) patients, severe chronic obstructive pulmonary disease in 10(16.7%) and severe anemia in 9(15%) patients. All individuals associated with co-morbidity were considered high-risk patients. CONCLUSION Laparoscopic drainage of liver abscess has a shorter surgical time, lower morbidity rate, and shorter hospital stay as compared to open surgical drainage.

Epidemiology, Clinical Features, and Outcome of Liver Abscess: A Single-Center Experience.

Introduction Liver abscesses are rare, but whenever they occur, it is predominantly among males over 60 years of age.The paradigm in the treatment has changed, and percutaneous drainage is now the initial treatment for drainage of the abscesses. Open surgery is reserved for patients with septated abscesses and those greater than 5 cm. Objective To study the etiological, clinical, pathological, and demographic characteristics of individuals with liver abscesses and to evaluate the outcome associated with different treatment strategies. Methods This clinico-epidemiological study was carried out at a tertiary care hospital in Jodhpur. One hundred patients with liver abscesses were studied.Patients were assigned to three groups: Group 1 - medical management alone (in non-aspirable uncomplicated abscess), Group 2 - USG-guided needle aspiration or pigtail percutaneous catheter drainage plus medical management (in unruptured aspirable abscess), Group 3 - open surgical drainage plus medical management (In ruptured abscesses). Of the total patients, 36% were treated with medical therapy alone, 45% with USG-guided needle aspiration, 10% with USG-guided percutaneous catheter drainage, and 9% with open surgical drainage. Results In our study, fever and hepatomegaly were the commonest presentations, observed in 91% and 62% of cases, respectively. Escherichia coli (E.coli) was the predominant organism cultured in 28 (43.75%) patients followed by Klebsiella growing in 24 (37.50%) patients. The right lobe was affected more (83%) than the left lobe and in the majority (83%), a solitary abscess was present. The mean age of liver abscess presentation was 40.72 years, with a 5.67:1 male-to-female ratio.Alcohol consumption was reported by 33% of patients, the majority of whom were men. Serum bilirubin was elevated in 56% of liver abscess patients, while it was normal in 44%. The mean serumbilirubin was 2.08 mg/dl. The mean value in group 1, group 2, and group 3 was 1.44 mg/dl, 2.23 mg/dl, and 2.57 mg/dl, respectively. Liver abscesses were identified in 76% of patients with right lobes; 83% had solitary liver abscesses and 17% had numerous abscesses. Abscess culture showed E. coli in 21 (32.81%) and Klebsiella in 17 (26.56%) patients. Conclusion Right-sided solitary pyogenic liver abscess caused by E.coli is the most common liver abscess, with fever and hepatomegaly as the most common presentation. Non-aspirable liver abscesses, regardless of aetiology, can be successfully treated by medical therapy alone. Needle aspiration or catheter drainage is standard for liver abscesses. Thus, needle aspiration has replaced the surgical exploration of liver abscesses.

Large Solitary Pyogenic Liver Abscesses: A Review of Their Management at a Tertiary Care Hospital.

Background and objectiveLiver abscesses are one of the common surgical diseases to be treated as an emergency in any tertiary care hospital in India. The formation of abscesses in the liver is still a major problem and associated with significant morbidity in developing countries. We come across all types of liver abscesses, such as amoebic (most common), pyogenic, mixed, and occasionally fungal. There have been several studies on the percutaneous modality of treatment for pyogenic liver abscesses. Most of the studies suggest that percutaneous catheter drainage (PCD) offers a better approach than aspirations for treating pyogenic liver abscesses. However, a few recent studies suggest that percutaneous aspiration leads to equally good results when compared to percutaneous drainage. In this study, we aimed to review the management of solitary large pyogenic liver abscesses and to assess the effectiveness of ultrasonography (USG)-guided aspiration in the procedure. MethodsA retrospective study was carried out at the Department of General Surgery of our institute. In this study, a total of 27 patients treated for solitary pyogenic liver abscess were included. All patients with a large liver abscess greater than 5 cm without the features of frank peritonitis were included. These patients were followed up regularly for six months.ResultsThe single-attempt USG-guided aspiration was successful in 70.3% of patients. Repeat USG-guided aspiration was performed in 18.5% of patients. In 7.4% of patients, a USG-guided percutaneous pigtail catheter was placed. And only 3.7% of cases required exploratory laparotomy. ConclusionBased on our findings, USG-guided aspiration is a fairly efficient method for treating a large solitary pyogenic abscess with acceptable results, shorter hospital stays, and minimal complications.

Direct Puncture Pigtail Catheter Placement for Secure Management of the Liver Abscess

Background: Liver abscess is a common cause of morbidity and mortality in developing countries. The availability of advanced imaging in developing countries has led to diagnosis and treatment of patients at an early stage and management with local anesthesia. ObjectiveThe objective was to establish direct puncture pigtail catheter placement as a secure management method for liver abscess drainage. MethodsOur prospective study was performed on 170 patients at our tertiary hospital for 2 years between April 2019 and March 2021. Patients diagnosed with liver abscess on ultrasonography (USG) were included in our study. Percutaneous drainage of the abscess is done, and serial USG scans were performed to determine the effectiveness of the procedure. ResultsOut of the 170 patients with a liver abscess who have undergone USG-guided pigtail catheterization for solitary liver abscess (size greater than 5 cm), the occurrence was predominantly in the right lobe (69.5%), with volume more than 150 cc. The study showed no significant complications with a success rate of 98%. ConclusionsUSG-guided percutaneous drainage of liver abscess is minimally invasive with a satisfactory outcome to mark it as the first line of management in liver abscess.

COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS PIGTAIL CATHETER DRAINAGE FOR SOLITARY LIVER ABSCESS.

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.

Management Strategies and Clinicopathological Evaluation of Liver Abscess in the Tribal Area: A Cross Sectional Study

Background: Liver abscess continues to be disease with considerable mortality in our country especially in Tribal Area. Locally made alcoholic drinks like neera, arrack may be the routes of faeco-oral transmission of amoebic cysts. Hence the aim of the study was to study the influence of alcohol, diabetics &amp; immunocompromised diseases leading to increased incidence of Liver abscess and to evaluate efficacy associated with most effective treatment. Subjects and Methods: The present study included 50 patients diagnosed with liver abscess. All the patients were under the treatment for the period of years. All cases of liver abscess diagnosed clinically and/or ultrasonographically, all cases of bacterial and parasitic liver abscess and the cases in evolving, liquefied &amp; ruptured stage with or without peritonitis were included in the study. Results: When the management part of the liver abscess was analysed 14 patients had abscess that was less than 200 cc or had multiple small abscess involving both lobes that were managed conservatively. Total of 36 patients who had abscess &gt; 200 cc or left lobe abscess were subjected to intervention, of which 24 patients were treated with percutaneous aspiration with antibiotic coverage, 6 patients were treated with laparotomy procedure and 4 patients treated with drainage with laparoscope and 2 patients underwent ICD insertion. Conclusion: Liver abscess is a common condition in tribal area of India. It is still, a disease associated with considerable morbidity. Intraperitoneal rupture, pleural rupture, septicemia are the conditions that can occur. Multiple small liver abscess and solitary liver abscess &lt; 200 cc or size &lt; 5cms can be successfully managed with conservative line of management with antimicrobials / antiamoebic drugs, but recurrences were noted. Percutaneous needle aspiration as well as Pigtail Catheter insertion is safe and highly effective method of managing liver abscess cases. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

Hybrid minimally invasive interventions in the treatment of solitary cholangiogenic liver abscesses

Treatment of solitary cholangiogenic liver abscesses is considered in the article. Successful treatment of cholangiogenic liver abscess with hybrid technologies is reported. The authors conclude that restoration of bile outflow is essential for fast elimination of the abscess.

USG guided pigtail catheter placement for drainage of liver abscess as a minimally invasive procedure

Background: The objective of the study was to evaluate the advantages of USG guided pigtail catheter placement for drainage of liver abscess as a minimally invasive procedure.Methods: This is a retrospective study conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, April 2017 to August 2017. It included 45 patients who were diagnosed with solitary liquefied liver abscess. The effectiveness of drainage was determined by doing serial USG scans.Results: Age group varied from 27 to 52 years. Out of 45 patients 41 were men and 4 were women. The male to female ratio was 10:1. All the patients underwent USG guided pigtail catheter insertion for solitary liver abscess. Average hospital stay varied from 2–3 days. No complications were observed during the procedure.Conclusions: This study concludes that drainage of solitary liver abscess by USG guided pigtail placement as a minimally invasive procedure was good in clinically improving the patient’s general condition &amp; decreasing the size of abscess cavity.

Percutaneous treatment of liver abscess - outcomes.

IntroductionMixed bacterial flora are responsible for the development of numerous abscesses, particularly those that are a consequence of systemic infection (septicaemia) originating from pathologies within abdominal organs or biliary ducts. The number and volume of abscesses may vary, which influences the method of treatment.AimTo assess the effectiveness of a minimally invasive percutaneous drainage of liver abscesses.Material and methodsA total of 37 patients were treated for liver abscess in the years 2007–2016. The treatment involved sonographically guided percutaneous drainage of liver abscess.ResultsA total of 35 patients with a solitary abscess were successfully cured with minimally invasive percutaneous drainage. Two patients with abscesses volume > 20 cm3 were treated surgically after ineffective percutaneous drainage.ConclusionsPercutaneous drainage is effective in the treatment of solitary liver abscesses volume < 5 cm3. Irregularly shaped abscesses are effectively drained with multisite drainage. Hybrid drainage (endoscopic and percutaneous) is a method of choice in the treatment of abscesses resulting from biliary duct obstruction. Statistical significance regarding inflammatory markers was found only for C-reactive protein (CRP), because it correlated with the effectiveness of drainage, i.e. the possibility of drainage effectiveness decreased with the increase in CRP values.

A Prospective Comparative Study to evaluate drainage of liver abscess by 20 Fr PVC catheter versus 10 Fr pigtail catheter

Background: Large liver abscess requires drainage by pigtail catheter. These catheters tend to get blocked frequently and thus takes long period of time to completely drain. So we wanted to study whether inserting a large bore catheter would drain the abscess faster thus decreasing the stay and requirement of antibiotics. Aim: To study the effectiveness of wide bore PVC catheter (20 Fr) in drainage of large peripheral liver abscess as compared to the use of pigtail catheter (10 Fr). Methods: The study was prospective comparative study done at a tertiary care hospital. Over a period of 22 months, 60 patients of amoebic liver abscess were assigned to undergo pigtail catheter drainage by 10 Fr. Versus wide bore 20 Fr PVC catheter drain and the outcomes were compared. Results: Use of wide bore (20 Fr) PVC catheter significantly decreased the duration of treatment, led to faster drainage of abscess and decreased incidence of recurrence in large amoebic liver abscess, as compared to pigtail catheter drainage by the standard 10 Fr pigtail catheter. Conclusion: 20 Fr PVC catheter is safe and efficacious for evacuating large solitary peripheral liver abscesses and should be preferred to narrow bore pigtail catheter.

Amoebic liver abscess: a report from central India.

Amoebic liver abscess is a serious but curable hepatic illness predominantly seen in tropical countries. We describe our experience of clinical presentation, laboratory parameters, radiological findings and treatment strategies. This is a retrospective analysis of 114 patients who were admitted from January 2012 to September 2014 at our centre. The mean age of presentation was 41.7 ± 13.9 years, the majority of patients were male (86.8%) with chronic alcoholism (63.2%). Most of the patients had a solitary right lobe liver abscess. Abdominal pain, fever, tachycardia and hepatomegaly were the most common clinical findings while hypoalbuminaemia, anaemia, leucocytosis and electrolyte imbalance were the most common laboratory abnormalities. A significant number of patients could be managed with antibiotics only (45.6%), percutaneous radiological drainage techniques being an important adjunct in selected cases (percutaneous needle aspiration, 20.2%; percutaneous pigtail catheter drainage, 30.7%). Surgical intervention was required in only a few cases (3.5%). Mortality was 3.5%.

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

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.

A study of predictors for identification of risk of complications in patients with liver abscess.

Liver abscess is a significant health problem in developing countries and the complications associated with it are frequently fatal. Hence identification of these complications and anticipating the same will lead to reduction in the mortality and morbidity rate. Such a work will facilitate in identifying patients with risk of complications and will allow for planning of an early intervention. The aim of this study was to identify the predictors of risk of complications in patients with liver abscess. The data for this retrospective study was obtained from hospital records and included 100 patients diagnosed to have solitary or multiple liver abscess. Complications were defined and history, lab and radiological findings and course of treatment were observed and analyzed in correlation with occurrence of complications. A predictive scoring system was designed for 15 points by giving two points to the factors with 100% correlation and one point to other factors with strong correlation. The score was applied to a validation cohort of 114 different patients and results were noted. Out of the 100 cases studied 24 cases had complications of and the predictive factors included history of alcoholism (> 10 yrs), INR > 1.7 , TLC > 20000/cc and pleural effusion, while other factors had a varying degree of correlation with complication occurrence. It was observed that the new scoring system was successful in identifying patients at risk of developing complications with 100% sensitivity and 93.75% specificity. Management of liver abscess can be clearly defined by dividing patients into categories depending upon a new scoring system described in the study and intervention can be planned.

Unusual liver abscess secondary to ingested foreign body: laparoscopic management

Liver abscess is a cause of febrile abdominal pain and usually the origin of a liver abscess is ascending cholangitis, hemathological diffusion, via the portal vein or the hepatic artery, or superinfection of necrotic tissue. Solitary pyogenic abscess with no obvious systemic cause may be secondary to a local event such as the migration of an ingested foreign body. We report the case of a solitary liver abscess caused by an ingested foreign body, a fish bone, migrated through the gastric wall into the left lobe.

An Unusual Complication of Liver Abscess

A 58-year-old diabetic female, presented to our emergency room with 5 days history of high-grade fever and pain in right hypochondrium. Prior to admission in our hospital she was diagnosed to have a solitary right lobe amoebic liver abscess (44 × 37 mm) and was being treated with cefuroxime and metronidazole. At the time of presentation she had persistent fever, tachycardia and tender hepatomegaly. Laboratory investigations revealed hemoglobin 13.4 gm/dl, total leukocyte counts 16300/cumm, platelet count 240,000/cumm, with normal liver function renal function tests.

Amoebic Liver Abscess: An Appraisal

Amoebic Liver Abscess: An Appraisal

Multiple Amoebic Abscesses with Erythema Nodosum

Amoebiasis, a common parasitic infection in the tropics is most commonly associated with solitary liver abscess. Multiple hepatic, splenic and renal abscesses are a very rare presentation of extraintestinal amoebiasis in children. The authors report a 6-y-old girl who presented with a febrile illness, hepatosplenomegaly and erythema nodosum and was diagnosed to have multiple amoebic abscesses by imaging and aspiration cytology of a liver abscess. This is also the first case report of the association of erythema nodosum with extraintestinal amoebiasis in children.

A Case of Pyogenic Liver Abscess Infected with Fusobacterium necrophorum Depicted by Microscopy and Confirmed by Tissue Culture

A 40-year-old man was admitted with a continuous high grade fever accompanying a relatively large solitary liver abscess with septations. A puncture of the abscess revealed gram-negative rods that could be identified histologically as Fusobacterium necrophorum, which was later confirmed by tissue culture. The patient was switched to meropenem and penicillin, and cured of the infection. Fusobacterium necrophorum is a rare bacterium causing potentially fatal liver abscesses in humans. Clinicians should bear Fusobacterium necrophorum in mind when treating patients with an enlarged solitary liver abscess.