A study of different treatment modalities in management of liver abscess at tertiary care center

Upadhyay Prabhakar Indrajeet; Alok Tripathi; Saurabh Agrawal; Mayank Mishra

doi:10.18203/2349-2902.isj20231963

Authors

Upadhyay Prabhakar Indrajeet Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
Alok Tripathi Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
Saurabh Agrawal Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
Mayank Mishra Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231963

Keywords:

Liver abscesses, Conservative management, Surgical management

Abstract

Background: Of all the visceral abscesses, the liver accounts for 48%. When a purulent substance collects in the liver parenchyma as a result of bacterial, parasite, fungal, or combination infections, it is called liver abscess. It is prevalent in India, accounting for the second largest prevalence, owing to insufficient sanitation, overcrowding, and malnutrition. As the liver is a susceptible organ to producing abscesses, whereas amoebic liver abscess is the utmost frequent kind of abscess in the developing world’s tropical regions, pyogenic abscess is more prevalent in affluent nations. The aims and objectives were to study the etiology, clinical manifestation, and predisposing factors of liver abscess; to compare the conservative and surgical treatment modalities of liver abscess; and to find out the outcome of these patients.

Methods: After matching inclusion and exclusion criteria, 100 clinically diagnosed liver abscess patients were enrolled for this retrospective and prospective observational study. Patients were analysed for ultrasonography whole abdomen, complete blood picture and liver function test and subjected to conservative or surgical management.

Results: The study group of 100 patients consisted of 83 (83%) male and 17 (17%) female with mean age of 40 years (18-70). 89 (89%) patients managed conservatively and 11 (11%) patients underwent for surgery. Patients with conservative management were found to have significant differences between outcome.

Conclusions: This study concludes that conservative management has significantly better outcomes as compared to surgical management.

Metrics

Metrics Loading ...

References

Dori F, Dennis L. Liver abscess. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal medicine. 15th ed. New York: McGraw-Hill Inc; 2000: 832-3.

Channanna C, Rehman FU, Choudhari B, Patil A. A clinical study, diagnosis and management of liver abscess at VIMS, Bellary. J Evidence Based Med Health Care. 2014;1(7):668-85.

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

Haque R, Duggal P, Ali IM, Hossain MB. Innate and acquired resistance to amebiasis in Bangladeshi children. J Infect Dis. 2002;186(4):547-52.

Ralston KS, Petri WA. Tissue destruction and invasion by Entamoeba histolytica. Trend Parasitol. 2011;27(6):254-63.

Goldman L, Schafer AI. Bacteria, Parasitic, fungal and granulomatous infections. Goldman-Cecil Medicine Book. 25th ed. Elsevier; 2016: 375.

Oschner A, DeBakey M, Murray S. Pyogenic abscess of liver: II. An analysis of forty-seven cases with review of the literature. Am J Surg. 1938;40(1):292-319.

Meddings L, Myers RP, Hubbard J, Shaheen A, Laupland K, Dixon E, et al. A population -based study of pyogenic liver abscess in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2010;105:117-24.

Ribaudo JM, Ochsner A. Intrahepatic abscesses: amebic and pyogenic. Am J Surg. 1973;125(5):570-4.

Barnes S, Lillemoe K. Liver abscess and hydatid cyst disease. In: Zinner M, Schwartz S, Ellis H, Ashley S, McFadden D, eds. Maingot's Abdominal Operations, 10th ed. Stamford, CT: Appleton & Lange; 1997: 1513-45.

Pitt HA. Surgical management of hepatic abscesses. World J Surg. 1990;14(4):498-504.

Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, et al. Pyogenic hepatic abscess: Changing trends over 42 years. Ann Surg. 1996;223(5):600-9.

McFadzean AJS, Chang KPS, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics: A report of 14 consecutive cases with recovery. Br J Surg. 1953;41(166):141-52.

Croisille Y, Le Douarin NM. Development and regeneration of the liver. In: DeHaan RL, Urspung H, eds. Organogenesis. New York: Holt, Rinehart & Winston; 1965.

Bennett D. Modern views of embryonic development and differentiation. In: Javitt NB, eds. Neonatal Hepatitis and Biliary Atresia: An International Workshop. Bethesda: National Institutes of Health; 1977.

Pope IM, Poston GJ. Pyogenic liver abscess. In: Blumgart LH, Fong Y, eds. Surgery of the Liver and Biliary Tract. 3rd ed. London, England: WB Saunders; 2001: 1135-45.

Ochsner A. Pyogenic abscess of the liver. Am J Surg. 1938;40:292.

Abbas MT, Khan FY, Muhsin SA, Al-Dehwe B Abukamar M, Elzouki A, et al. Epidemiology, clinical features and outcome of liver abscess: a single reference center experience in Qatar. Oman Med J. 2014;29(4):260-3.

Wurez T, Kane JB, Boggild AK Krajden S, Keyston JS, Fuksa M, et al. Review of amoebic liver abscess for clinicians in a nonendemic setting. Can J Gastroenterol. 2012;26(10):729-33.

Ghosh S, Sharma S, Gadpayle AK, Gupta HK, Mahajan RK, Sahoo R, et al. Clinical, laboratory, and management profile in patients of liver abscess from Northen India. J Trop Med. 2014;2014:142382.

Cheema HA, Saaed A. Etiology, presentation and management of liver abscess at Children’s Hospital Lahore. Annals King Edward Med Uninv. 2008;14(4):148-50.

Zafar A, Ahmed S. Amoebic liver abscess: a comparative study of needle aspiration vs conservative treatment. J Ayub Med Coll Abbottabad. 2002;14(1):10-2.

Dutta A, Bandhopadhyay S. Management of liver abscess. Med Update. 2012;22:469-75.

Jha AK, Das A Chowdhury F, Biswas MR, Prasad SK, Chattopadhyay S. Clinicopathological study and management of liver in a tertiary care centre. J Nat Sci Biol Med. 2015;6(1):71-5.

Choudhary V, Chaudhary A. A clinicopathological profile of liver abscess: a prospective study of 100 cases. Int Surg J. 2016;3(1):266-70.

Hathila TN, Patel CJ, Rupani MR. A cross sectional study of clinical feature and management of liver abscesses in a tertiary care hospital, Ahemdabad, Gujrat. Natnl J Med Res. 2014;4(3):250.

Hayat Z, Mahmood S, Ali M, Nishtar N, Sartaj N, Neaem F, et al. Liver abscess not an uncommon disease. J Postgard Med Inst. 1995;9(1):56-61.

Ahsan T, Jehangir MU, Mahmood T, Ahmed N, Saleem M, Shahid M, et al. Amoebic vs pyogenic liver abscess. J Pak Med Assoc. 2002;52(11):497-501.

Singh S, Chaudhary P, Saxena N, Khandelwal S, Poddar DD, Biswal UC. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol. 2013;26(4):332.

Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ, et al. Diagnosis and management of complicated intra abdominal infection in adults and children: guidelines by the surgical infection disease society of American. Clin Infect Dis. 2010;50(2):133-46.

Rajak CL. Percutaneous treatment of liver abscess: needle aspiration vs catheter drainage. AJR Am J Roentgenol. 1998;170(4):1035-9.

Cai Y, Xiong X, Lu J, Cheng Y, Yang C, Lin Y, et al. Percuatneous needle aspiration vs catheter drainage in the management of liver abscess: a systemic review and meta-analaysis. HPB. 2015;17(3):195-201.

Lee CH, Jo HG, Cho EY, Song JS, Jung GM, Cho YK, et al. Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patient with pyogenic liver abscess. BMC Infect Dis. 2021;2(1):1.

Musa O, Khan MF, Shukla BN, Ansari NA, Rathore B. A comparative study of conservative management vs USG guided aspiration of small amoebic liver abscess. Era J Med Res. 2020;7(2):165-71.

Banasal A, Bansal AK, Bansal V, Kumar A. Liver abscess: catheter drainage v/s needle aspiration. Int Surg J. 2015;2(1):20-5.

Sharma N, Sharma A, Varma S, Lal A, Singh V. Amoebic liver abscess in the medical emergency of north Indian hospital. BMC Res Note. 2010;3(1):1-4.

Singh JP, Kashyap A. A comparative evaluation of percutaneous catheter drainage for resistant amebic liver abscess. Am J Surg. 1989;158(1):58-62.

Baek SY, Lee MG, Cho KS, Lee SC, Sung KB, Auh YH. Therapeutic percutaneous aspiration of hepatic abscesses: effectiveness in 25 patients. AJR Am J Roentgenol. 1993;160(4):799-802.

Giorgio A, Tarantino L, Mariniello N, Francica G, Scala E, Amoroso P, et al. Pyogenic liver abscesses:13 years of experience in percutaneous needle aspiration with US guidance. Radiology. 1995;195(1):122-4.

Goel V, Jain A, Sharma G, Jhajharia A, Agarwal VK, Ashdhir P, et al. Evaluating the efficacy of nitazoxanide in uncomplicated amebic liver abscess. Ind J Gastroenterol. 2021;4(3):272-80.