A comparative study of various modalities of treatment of liver abscess

In the 54 selected cases 47 cases are having amoebic liver abscess and 7 patients are having pyogenic liver abscess. • Amoebic liver abscess is commonly seen in the age group between 30-50 years and the pyogenic liver abscess commonly seen in the age group more than 60 years. • In amoebic liver abscess males are commonly affected than the females (8.4 : 1). In pyogenic liver abscess there is equal distribution with slight difference (1.3 : 1). • All the patients included in the study are belonging to low socioeconomic groups. • Right lobe abscess in 48 patients, left lobe abscess in 5 patients, both lobes abscess in one patient. • In amoebic liver abscess 85.7% patients are having abdominal pain. It is higher than pyogenic liver abscess. Fever is seen all the patients of pyogenic liver abscess. In both types half of the patients and one third of the patients having vomiting and diarrhoea. • Tenderness and hepatomegaly is common in amoebic liver abscess and jaundice is common in pyogenic liver abscess patients. • < 5cm abscess the treatment is drugs alone. Metronidazole for amoebic abscess and antimicrobials for pyogenic abscess. • >5cm abscess ultrasound guided aspiration, percutaneous catheter drainage, laparoscopic drainage method .any one can be opted with drugs. • In case of rupture and multiple abscess open surgical method is ideal. • In laparoscopic drainage method 50% reduction of the abscess cavity seen in most of the patients with in a day in percutaneous method within 3 days in needle aspiration up to a week some patients require 10-15 days. • The duration of hospital stay is 4 days in laparoscopic drainage method, 5 days in percutaneous catheter drainage, 7-10 days in needle aspiration method. • No secondary procedure needed in laparoscopic method. Two third of the patients required secondary procedure in ultrasound guided needle aspiration. • No complication occurred in laparoscopic method. Infection rate is high in percutaneous catheter drainage and open surgical method. • 100% recovery rate is higher in patients treated with laparoscopic method. 80% recovery rate is higher in patients treated with percutaneous drainage and needle aspiration method. CONCLUSION: In case of abscess size is less than 5 cm drugs alone is enough. If the abscess size is more than 5 cm and large abscess without complications any one of the following method of treatment options may be carried out: 1. Ultrasound guided needle aspiration with drugs, 2. Percutaneous catheter drainage method drugs, 3. Laparoscopic drainage method with drugs. Among these the best option is laparoscopic drainage method. If the abscess has ruptured with peritonitis open surgical method is best option. In multiple abscesses both laparoscopic method and open surgical methods can be tried. To minimise the hospital stay laparoscopic drainage method is the best method