Liver abscess - Different modalities of treatment and its outcome

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.