Clinicopathological study on presentation, diagnosis and management of liver abscess in Bhopal region

Authors

  • Anshul Siroliya Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • Mahendra Damor Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India
  • M. C. Songra Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20173391

Keywords:

Amoebic, Catheter drainage, Liver abscess, Pyogenic

Abstract

Background: This prospective observational study is carried out to study cases of liver abscess and to determine demographic profile, spectrum of clinical presentations, aetiology, laboratory investigations. The objective of the study was to evaluate efficacy of Ultrasonographic (radiological) studies in determining the aetiology and in differentiating from other liver pathologies which may change the treatment outcome, bacteriological and serological characteristics, to study the influence of alcohol, diabetics and immunocompromised diseases (esp. HIV) leading to increased incidence of liver abscess and to evaluate efficacy, recurrence rate, complications, morbidity and mortality, duration of hospital stay associated with different management Strategies.

Methods: This prospective observational study was carried out in Department of Surgery, Gandhi Medical College Bhopal and Associated Hamidia Hospital, Bhopal between July 2015 to October 2016.

Results: Amoebic abscess (74%) is more common than pyogenic abscess (26%). Amoebic abscess is common in the age group of 31-50 years (73%), pyogenic in the age group of 51-70 years (73.1%). Male preponderance is found in case of amoebic liver abscess (90.5%). Right lobe involvement in common. Right upper quadrant pain, tenderness and fever are the most common clinical features. Alcoholism is most common risk factor (71.6%) and diabetes mellitus has strong association with pyogenic liver abscess (15.4%). E coli (19.2%) and klebsiella (11.5%) are the most common organisms cultured. Medical therapy is more useful in case of amoebic liver abscess (58.1%) while catheter drainage is more useful in case of pyogenic liver abscess (61.5%). Pleuropulmonary complications are much more common and complications rate is more common among pyogenic group.

Conclusions: In our study, alcohol was found to be the most common predisposing factor for liver abscesses (68%), this underpin the finding of other studies. Amoebic liver abscess is a medically treated common infection prevailing in unhygienic condition, affecting people mostly between 30-40 years of age whereas pyogenic liver abscess patient commonly falls between 50-70 years age group. Both liver abscesses show a male preponderance. The present study also corroborates the catheter drainage procedure as a superior modality in treating pyogenic liver abscess.

Author Biographies

Anshul Siroliya, Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

ASISSTANT PROFESSOR

Department of general surgery

gandhi medical college, bhopal. m.p

Mahendra Damor, Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

R S O

Department of general surgery

gandhi medical college, bhopal. m.p

 

M. C. Songra, Department of General Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Professor & HOD

Department of general surgery 

gandhi medical college.bhopal.m.p

References

Wong WM, Wong BC, Hui CK, Ng M, Lai KC, Tso WK, et al. Pyogenic liver abscess: Retrospective analysis of 80 cases over a 10‐year period. J Gastroenterol Hepatol. 2002;17(9):1001-7.

Seeto RK, Rockey DC: Pyogenic liver abscess: Changes in etiology, management, and outcome. Medicine (Baltimore). 1996;75:99-113.

Sabbaj J, Sutter VL, Finegold SM: Anaerobic pyogenic liver abscess. Ann Intern Med. 1972;77:627-38.

Chemaly RF, Hall GS, Keys TF, Procop GW. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures. Diag Microbiol Infect Dis. 2003;46(4):245-8.

Conter RL, Pitt HA, Tompkins RK. Differentiation of pyogenic from amebic hepatic abscesses. Surg Gynecol Obstet. 1986;162:114-120.

Lodhi S, Sarwari AR, Muzammil M. Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. Trop Med Int Health. 2004;9:718-23.

Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis. 1999;29:1117-25.

Sharma N, Sharma A, Varma S, Lal A, Singh V. “Amoebic liver abscess in the medical emergency of a north Indian hospital,” BMC Research Notes. 2010;3(21).

Mukhopadhyay M, Saha AK, Sarkar A, Mukherjee S. Amoebic liver abscess: presentation and complications. Ind J Surg. 2010;72(1):37-41.

Ochsner A, DeBakey M, Murray S. Pyogenic abscess of the liver. Am J Surg. 1938;40:292-314.

Johannsen EC, Sifri CD, Madoff LC. Pyogenic liver abscesses. Infect Dis Clin North Am. 2000;14:547-63.

Kimura K, Stoopen M, Reeder MM. Amebiasis: modern diagnostic imaging with pathological and clinical correlation. Semin Roentgenol. 1997;32:250-75.

Hughes MA, Petri Jr WA: Amebic liver abscess. Infect Dis Clin North Am. 2000;14:565-82.

Ralls PW, Henley DS, Colletti PM. Amoebic liver abscess: MR imaging. Radiol. 1987;165:801-4.

Wells CD, Arguedas M: Amoebic liver abscess. South Med J. 2004;97:673-82.

Ramani A, Ramani R, Shivananda PG. Amoebic liver abscess. a prospective study of 200 cases In a rural referral hospital in south India Bahrain Medical Bulletin. 1995;17(4).

Joshi VR, Kapoor OP, Purohit AV. Jaundice in amoebic abscess of liver. J Assoc Phy India. 1972;20(10):761-4.

Huang CJ, Pitt HA, Lipsett PA. Pyogenic hepatic abscess: Changing trends over 42 years. Ann Surg. 1996;223:600-7.

Alvarez Perez JA, Gonzalez JJ, Baldonedo RF. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg. 2001;181:177-86.

Branum GD, Tyson GS, Branum MA. Hepatic abscess: changes in etiology, diagnosis, and management. Ann Surg. 1990;212:655-662.

Mohsen AH, Green ST, Read RC. Liver abscess in adults: ten years’ experience in a UK centre. Q J Med. 2002;95:797-802.

Rahimian J, Wilson T, Oram V. Pyogenic liver abscess: Recent trends in etiology and mortality. Clin Infect Dis. 2004;39:1654-9.

Halvorsen RA, Korobkin M, Foster WL. The variable CT appearance of hepatic abscesses. AJR Am J Roentgenol. 1984;142:941-6.

Hira PR, Iqbal J, Al-Ali F. Invasive amoebiasis: challenges in diagnosis in a non-endemic country (Kuwait). Am J Trop Med Hyg. 2001;65:341-5.

McGarr PL, Madiba TE, Thomson SR. Amoebic liver abscess: results of a conservative management policy. S Afr Med J. 2003;93:132-6.

Chen C, Chen PJ, Yang PM. Clinical and microbiological features of liver abscess after transarterial embolization for hepatocellular carcinoma. Am J Gastroenterol. 1997;92:2257-9.

Adams EB, MacLeod IN. Invasive amebiasis: II. Amebic liver abscess and its complications. Medicine (Baltimore). 1977;56:325-34.

Stanley Jr SL. Amoebiasis. Lancet. 2003;361:1025-34.

Balasegaram M. Management of hepatic abscess. Curr Probl Surg. 1981;18:282-340.

Crane PS, Lee YT, Seel DJ. Experience in the treatment of two hundred patients with amebic abscess of the liver in Korea. Am J Surg. 1972;123:332-7.

Sharma MP, Dasarathy S, Verma N. Prognostic markers in amoebic liver abscess: A prospective study. Am J Gastroenterol. 1996;91:2584-8.

Stanley SL. Amoebiasis: seminar. Lancet 2003;361(9362):1025-34.

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Published

2017-07-24

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Original Research Articles