A CLINICAL STUDY TO EVALUVATE THE TREATMENT MODALITIES OF LIVER ABSCESSES

Dinesh Dutt Sharma; Ajay Malviya; Seema Sharma; Keshav Sharma; Rakesh Rathore; Pawan Kumar; Neha Sharma

Volume : VIII, Issue : III, March - 2019

A CLINICAL STUDY TO EVALUVATE THE TREATMENT MODALITIES OF LIVER ABSCESSES

Dinesh Dutt Sharma, Ajay Malviya, Seema Sharma, Keshav Sharma, Rakesh Rathore, Pawan Kumar, Neha Sharma

Abstract :

Background : A liver abscess is a pus–filled mass inside the liver. There are three major forms of liver abscess, classified by etiology, viz., amoebic abscess due to Entamoeba histolytica being the most type in tropical countries like India, followed by pyogenic abscess, which is most often polymicrobial and the least common being fungal abscess, most often due to Candida species. Aims and Objectives: This study aimed to access the effectiveness of various modalities of treatment of liver abscesses viz., antibiotics alone, sonographic guided percutaneous drainage with antibiotics and open surgical drainage. Materials and Methods: This was an interventional prospective clinical study carried out on inpatients admitted in Mahatma Gandhi Hospital, Jodhpur. Informed written consent was obtained from all the patients who participated in the study before starting protocol wise treatment. A pre designed proforma was used to collect relevant data from the patients included in the study. Patient were assigned into three groups, according to the treatment modality: Group ‘A‘ – Patient given medical management only. Group ‘B‘ – Patient given percutaneous drainage with medical management. Group ‘C’ – Patients treated by open surgical drainage. Observations: The study was conducted on a total of 100 patients, diagnosed with liver abscess. In our study, medical management alone was successful in 31% cases, ultrasound guided percutaneous drainage was done in 62% of cases, while the rest 7% of them underwent open surgical drainage. Discussion: Although the primary mode of treatment of amoebic liver abscess is medical, 15% of amoebic abscesses may be refractory to medical therapy. Also, secondary bacterial infection may complicate up to 20% of amoebic liver abscesses. And hence drainage may be required in many patients with amoebic liver abscesses. Abscesses smaller than 5cm size can be managed by parenteral antibiotic therapy alone while those above 5cm size are usually managed by ultrasound guided percutaneous aspiration/drainage. Very large ones (>10cm) and multi–loculated abscesses with exaggerated necrotic process need to be operated. Patients with advanced age, abscess size > 5 cm, involvement of both lobes of the liver and duration of symptoms more than 7 days are likely to undergo aspiration of the liver abscess, regardless of aetiology. In addition to abscess size, other criteria for percutaneous drainage include continued pyrexia after 48–72 hours of adequate medical treatment, and clinical or ultrasonographic features suggesting impending perforation. Conclusion: Liver abscesses continue to be an important cause of morbidity and mortality in tropical countries. Percutaneous drainage is now considered the treatment of choice for most intra–abdominal abscesses and fluid collections.