Management of liver abscess at teaching hospital.

BACKGROUND: A current assessment of liver abscesses should allow for better understanding of the pathogenesis of the disease and improve the effectiveness of diagnosis and treatment. Amoebic liver abscess occurs more commonly than the pyogenic liver abscess on a worldwide basis. The purpose of the study is to investigate the clinical presentation and management option for liver abscess. METHODS: A prospective observational study was conducted from January 2007 to December 2010, in Kathmandu Medical College Teaching Hospital. We recorded and analyzed the clinical presentations, diagnostic modalities, treatment programmes of all liver abscesses. RESULTS: Liver abscess was more common in males, 24(85.7%) males and 4(14.3%) females, occurring more frequently in right lobe of liver. Most patients presented with nonspecific clinical and biochemical features. Twenty (71.4%) patients presented with chills & rigors. Five patients (17.8%) presented jaundice and none had transaminases raised but 15(56.3%) had raised alkaline phospahatases. Eight (28.5%) patients were treated with antibiotics alone. USG guided drainage was done in 12(42.8%) patients and 6(21.4%) required surgical exploration with laparoscopic deroofing in 2(7.1%) patients. The largest size was 1100cc.with right lobe predominance in 20(76.9%) patients and single lobe involvement in 22(78.4%) patients. Six (21.4%) patients had multiple liver lobes involved. Three (7.1%) patients had ruptured liver abscess and 3(7.1%) had right sided pleural effusion. Seventeen (60.7%) patients were diagnosed have amoebic liver abscess. Ten (35.7%) patients were found to have pyogenic liver abscess. One (3.5%) had tuberculosis. CONCLUSIONS: Liver abscess requires a high degree of suspicion for early diagnosis. When appropriate therapy in the form of antibiotics in combination with percutaneous drainage or surgery is administered the mortality is very low. However, significant morbidity is still a problem in old debilitated persons with other core morbidities.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy.

INTRODUCTION: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. PATIENTS AND METHOD: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. RESULTS: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. CONCLUSION: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop.