Hepatic abscess

ABSTRACT

Thirty- four patients were included in this work. 18 were males, 16 were females, Age ranged from 8 to 85 years with a mean age of 42 years. Amoebiasis was responsible in 24 [70.6%] patients but in 18 [75%] patients of them secondary bacterial infection was found, Cholecystitis was responsible in 2 patients, generalized sepsis in 2, trauma in one. Carcinoma bile duct in one and unknown source in 4 patients. Streptococcal species were isolated in 37% of positive cultures, Escherechia coll in 33%. Bactcroides in 24%, Klebsiella pneumonia in 18% and microaerphillic streptococi in 12% growth was found in six patients. All patients received a combination of metronidazoh and aminoglycosides. Closed- open drainage after exploration of the abdomen was done except in three patients with multiple scattered abscesses where only specimens were taken for culture and sevsitivity. Intercostal tube drainage was in four patients. Three patients died due to generalized septicemia and multiple scattered hepatic abscesses in two patients and cholemia due to advanced carcinoma of common bile duct in the third patients. Associated cholecystectomy and common bile duct exploration was done in two patients, and rigid tube drainage of the common bile duct in one patient with inoperable cancer. Postoperative recovery was smooth in most survivals, six patients developed pneumoniae, deep vein thrombosis occured in one patient and wound sepsis in eight patient. Closed- open drainage seems to be reasonable line of treatment for our patients who came late with gigantic liver abscesses, left lobe abscesses, deep seated abscesses of the right lobe and ruptured hepatic abscesses