A Comprehensive study on various treatment modalities and its Outcome in liver abscess in our institution

BACKGROUND & OBJECTIVES : Incidence of liver abscess is constantly increasing in our country. Because of poor sanitation, and over crowding amoebic liver abscess more common in India, while pyogenic liver abscess more common in western population. The objective is to study the clinical presentations, various treatment modalities undergone by patients diagnosed as liver abscess in our institution. Also, to identify the outcomes in terms of clinical improvement, duration of hospital stay, morbidity & long term follow up. METHODOLOGY: Study was conducted in 52 patients diagnosed as liver abscess, who were admitted in Govt. Stanley medical college hospital, Chennai between February 2016 to September 2016 (8 months duration). Patients who satisfied inclusion & exlcusion criteria were included in our study. Necessary blood investigations, imaging like USG and CT scan used for diagnosing. Patients were treated with drugs alone, USG Guided needle aspiration, Percutaneous pigtail catheter drainage, Laparoscopic drainage, Open surgical drainage method. All these intervention procedures treated along with drugs. RESULTS: Out of 52 patients studied, 38 cases (73%) are having amoebic liver abscess and 12 (27%) 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 50 years. Most of them are single abscess cavity (52%) compared to multiple abscess cavity. Right lobe abscess seen in 42 patients (80%), left lobe abscess in 5 patients (10%), both lobes abscess in 5 patients (10%). In amoebic liver abscess, abdominal pain (85.7%), tenderness & hepatomegaly is the common presentation. Whereas in pyogenic liver abscess, fever & jaundice is the common presentation. 5cm abscess, intervention is carried out. Among these, 26 Patients were undergone pigtail procedure (50%), 8 patients undergone USG guided aspiration (15%), l patient undergone laproscopic drainage, 5 patients (10%) undergone laparotomy. Among cavity size, 5-10 cms is more common (29 patients). Time taken for 50% reduction of cavity size commonly falls between 7- 10 days. Among size of the cavity, < 5cm take longer time for 50% reduction compared to 5-10 cm since intervention is carried out. In pigtail drainage method 50% reduction of the abscess cavity seen in most of the patients with in 5-7 days, in needle aspiration similar reduction seen but secondary procedure is more .The duration of hospital stay is 7-10 days in percutaneous catheter drainage, compared to 10- 12 days in needle aspiration method. Only 10 patients undergone secondary procedure, two third of the patients required secondary procedure in ultrasound guided needle aspiration. Only 65% patients achieve almost complete remission by 6 weeks follow up. INTERPRETATION & CONCLUSION: In the abscess size is less than 5 cm, drugs alone is enough. If the abscess size is more than 5 cm and large abscess, intervention is carried out. Among the overall treatment procedures, pig tail drainage is most common procedure carried out in our institution. Except for increased hospital stay, being simple & effective, it remains the gold standard treatment of choice currently. Open surgical method is best, if the abscess has ruptured with peritonitis. Infection is the most common complication encountered. Conservartive treatment with drugs alone has less resolution in size of abscess cavity during follow up, compared to intervention methods