DOI: http://dx.doi.org/10.18203/2349-2902.isj20192356

Liver abscess: study of etiological factors and different treatment modalities and their clinical implications

Abhishek Khosla, Iqbal Ali, Varun Shetty

Abstract


Background: Hepatic abscess (HA) can be defined as an encapsulated collection of suppurative material within the liver parenchyma, which may be infected by bacterial, fungal, and/or parasitic micro-organisms. The development of new radiologic techniques, the improvement in microbiologic identification, and the advancement of drainage techniques, as well as improved supportive care, have reduced mortality to 5-30%. The study is undertaken to study the etiology and the impact of the modern methods of treatment on the morbidity and mortality on the different types of liver abscess..

Methods: This study was a Prospective Study conducted from July 2016 to September 2018. Participation in the study was purely voluntary.

Results: Majority of the patients (29%) were in the age group of 31-40 years with a male preponderance (91%). Diabetes mellitus was a common comorbidity in study subjects. Alcohol consumption was found as a significant risk factor in the development of liver abscess. Sixty eight (68%) patients underwent percutaneous needle aspiration and 27 (27%) patients were managed conservatively. Five (5%) patients required surgical intervention. Four (4%) patients died while 97 (97%) patients survived; 3 (3%) patients had undergone surgery while 1 (1%) patient was percutaneously drained.

Conclusions: The most common age group affected by liver abscess was third and fifth decade of life . Males are more commonly affected than females. In case of larger (>5 cm) or 150 ml, Ultrasound guided percutaneous pigtail catheter drainage is a superior therapeutic approach than percutaneous needle aspiration. Surgical intervention is reserved for unresponsive cases.


Keywords


Liver abscess, Percuatneous aspiration, Ultrasonography

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References


NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1990-May 1999, issued June 1999. A report from the NNIS System. Am J Infect Control. 1999;27(6):520-32.

Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals. Public Health Rep. 2007;122(2):160-7.

National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470-85.

Kumar A, Rai A. Prevalence of surgical site infection in general surgery in a tertiary care centre in India. Int Surg J. 2017;4(9):3101-6

Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002 Apr;15(2):167-93.

Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-7.

Chen CH, Wu SS, Chang HC, Chang YJ. Initial presentations and final outcomes of primary pyogenic liver abscess: a cross-sectional study. BMC Gastroenterol. 2014;14:133.

Sharma N, Sharma A, Varma S, Lal A, Singh V. Amoebic liver abscess in the medical emergency of a North Indian hospital. BMC Res Notes. 2010;3:21-24.

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

Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O, et al. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC Res. Notes. 2011;4:80-7.

Mohsen AH, Green ST, Read RC, McKendrick MW. Liver abscess in adults: ten years’ experience in a UK centre. QJM. 2002;95(12):797-802.

Bertel CK, Van Heeden JA, Sheedy PF II. Treatment of pyogenic hepatic abscesses: surgical vs PCD. Arch Surg. 1986;121(5):554-8.

Cohen JL, Martin FM, Rossi RL, Schoetz DJ. Liver abscess: the need for complete gastrointestinal evaluation. Arch Surg. 1989;124(5):561-4.

Greenstein AJ, Lowenthal D, Hammer GS, Schaffner F, Aufses AH Jr. Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients. Am J Gastroenterol. 1984;79(3):217-26.

Blumgart LH, Fong Y. Surgery of the Liver and Biliary Tract. London: WB Saunders; 2000: 35-64.

Blessmann J, Khoa ND, Van An L et al. Ultrasound patterns and frequency of focal liver lesions after successful treatment of amebic liver abscess. Trop Med Int Health. 2006;11(4):504-8.

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

Saptarshi B, Patra PS, Sultania S, Sarkar A, Hembram JR, Dhali GK. Percutaneous drainage may not be necessary in a significant subset of patients with complicated liver abscess. Trop Gastroentero. 2017;38(2):90-5.

Chang Z, Zheng J, Ma Y, Liu Z. Analysis of clinical and CT characteristics of patients with Klebsiella pneumoniae liver abscesses: an insight into risk factors of metastatic infection. Int J Infect Dis. 2015;33:50-4.