ABSTRACT
Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.
ABSTRACT
Background: Liver abscesses, both amoebic and pyogenic, is an important cause of morbidity and mortality in our country. It is a common condition in tropical countries. The primary mode of treatment of amoebic liver abscess is medical ; however many cases may need different type of surgical management. In the present study of liver abscess of different etiology, the following treatment modalities such as aspiration, percutaneous catheter drainage, laparoscopic drainage and open surgical procedure have been studied. Methods: A retrospective study was conducted from September 2007 to October 2008 on 50 liver abscess patients at Rajendra Institute of Medical sciences, Ranchi. Medical records were analysed for different modalities of treatment for amoebic liver abscess. Results: The mean age of patients was 39 years. Most of them were male alcoholics. Solitary abscess was found in right lobe of liver in 80% of cases. Most common presentation was right upper quadrant pain and fever. Abscesses were mainly amoebic. Percutaneous needle aspiration was done in 30%, 41% underwent USG guided pig tail catheter drainage and 5% of patients underwent for surgical interventions for peritonitis following ruptured liver abscess. The overall mortality rate seen in amoebic liver abscess was 7% in our series. Conclusions: Liver abscess is a very common condition in India and Amoebic liver abscess is more common than pyogenic liver abscess. More commonly occurs in young alcoholic males and most common presenting feature is right hypochondrial pain followed by fever. Most common sign include tender hepatomegaly. Ultrasound abdomen is the best method for diagnosis and intervention and in a few cases laparoscopic drainage or open surgical intervention required.