Effective treatment options in amoebic liver abscess in a tertiary care setting in West Bengal: an observational study, India
DOI:
https://doi.org/10.18203/2349-2902.isj20184641Keywords:
Abscess, Amoebic liver abscess, Aspiration, Catheter, Conservative treatment, Drainage, Laparotomy, Liver abscess, Open drainage, UltrasonographyAbstract
Background: Conservative management and image guided drainage have emerged as mainstay of the treatment in Amoebic Liver Abscess (ALA), with surgery used in complicated cases. The current study was conducted with an objective to demonstrate the effectiveness of the different treatment options in ALA.
Methods: An observational study was conducted on 100 patients, aged 19 to 60 years, admitted with sonographic evidence of Amoebic Liver Abscess (ALA) in the General Surgery wards of a tertiary care hospital in Kolkata. Patients coming for regular follow-up after completing treatment were included. On completion of the treatment before discharge a repeat ultrasonography of the upper abdomen was done to confirm remission.
Results: Majority of the patients were male, Muslim, rural resident and within 30 – 40 years age. Chief complaints were pain (100%), fever (60%) and abdominal swelling (80%). Tender hepatomegaly (80%) and icterus (36%) were present. Majority patients had the left lobe of the liver affected (72%) and abscess dimension <6 cms (66.67%). Out of the participants with unruptured abscess 21.87% had multiple abscesses. Out of 64 patients subjected to conservative therapy, 44 were successfully managed. Success rate of 72.73% was observed among 44 patients receiving ultrasound guided needle aspiration. All twenty patients subjected for pigtail catheter drainage were cured. Four patients underwent laparotomy and open drainage following intraperitoneal rupture.
Conclusions: Conservative treatment was observed to be sufficient in majority of cases of amoebic liver abscess of lesser size with percutaneous catheter drainage useful in large abscess. Surgical intervention was required in ruptured or complicated abscesses.
References
Entamoeba taxonomy. Bull World Health Organ. 1997;75(3):291-4.
Clark CG. Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 19 February 1998. Amoebic disease. Entamoeba dispar, an organism reborn. Trans R Soc Trop Med Hyg. 1998;92(4):361–4.
Diamond LS, Clark CG. A redescription of Entamoeba Histolytica schaudinn, 1903 (Emended Walker, 1911) separating it from Entamoeba Dispar Brumpt, 19251. J Eukaryot Microbiol. 1993;40(3):340–4.
Andrade RM, Reed SL. Amebiasis and Infection with Free-Living Amebas. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill Education; 2015.
Hoffner RJ, Kilaghbian T, Esekogwu VI, Henderson SO. Common presentations of amebic liver abscess. Ann Emerg Med. 1999;34(3):351-5.
Yeoh KG, Yap I, Wong ST, Wee A, Guan R, Kang JY. Tropical liver abscess. Postgrad Med J. 1997;73(856):89-92.
Lee JF, Block GE. The changing clinical pattern of hepatic abscesses. Arch Surg. 1972;104(4):465-70.
Hunter GW, Swartzwelder JC, Clyde DF, Mackie TT. Tropical medicine. 5th ed. Philadelphia: Saunders; 1976:900.
Ramani A, Ramani R, Kumar MS, Lakhkar BN, Kundaje GN. Ultrasound-guided needle aspiration of amoebic liver abscess. Postgrad Med J. 1993;69(811):381-3.
Zafar A, Ahmed S. Amoebic liver abscess: a comparative study of needle aspiration versus conservative treatment. J Ayub Med Coll Abbottabad. 2002;14(1):10-2.
Sharma MP, Ahuja V. Management of amebic and pyogenic liver abscess. Indian J Gastroenterol. 2001;20(1):C33-6.
Tandon A, Jain AK, Dixit VK, Agarwal AK, Gupta JP. Needle aspiration in large amoebic liver abscess. Trop Gastroenterol. 1997;18(1):19-21.
Salles JM, Moraes LA, Salles MC. Hepatic amebiasis. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2003;7(2):96-110.
Mohan S, Talwar N, Chaudhary A, Andley M, Ravi B, Kumar A. Liver abscess: a clinicopathological analysis of 82 cases. Int Surg. 2006;91(4):228-33.
Kapadia S, Duttaroy D, Godgaonkar P, Maru S. Percutaneous catheter drainage of liver abscesses. IJS. 64(6):516-9.
Hanna RM, Dahniya MH, Badr SS, El‐Betagy A. Percutaneous catheter drainage in drug-resistant amoebic liver abscess. Trop Med Int Health. 2000;5(8):578-81.
Hathila TN, Patel CJ, Rupani MP. A cross-sectional study of clinical features and management of liver abscesses in a tertiary care hospital, Ahmedabad, Gujarat. 4(3):4.
