JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : September Volume : 6 Issue : 36 Page : 2420-2422

CLINICAL PROFILE, COMPLICATIONS AND CURRENT MANAGEMENT OF AMOEBIC LIVER ABSCESS- A STUDY OF 100 CONSECUTIVE CASES

Sadashiv N. Chaudhari1, Ram P. Prajapati2, Abdul Khan3

Corresponding Author:
Dr. Sadashiv N. Chaudhari,
Assistant Professor, Department of General Surgery,
Seth GSMC and King Edward Memorial Hospital,
Parel, Mumbai, Maharashtra.
E-mail: drsadashiv@gmail.com
DOI: 10.18410/jebmh/2019/496

ABSTRACT
BACKGROUND
Amoebic Liver Abscess (ALA) in the Indian population has been relatively common and continues to have a significant morbidity in terms of days lost from work. The mortality rate of ALA cases reported to be around 11%-14% before 1984 and has reduced to around 1% at present. This article aims to review the trends in the clinical aspects of ALA in adult patients.

METHODS
This is a study of 100 consecutive patients diagnosed with liver abscess at a tertiary care center in Western India which were followed up in a prospective manner during their hospital stay and during readmissions. Ultrasonography (USG) and Computed Tomography (CT) were used as diagnostic tools. A pre-decided protocol of management was followed. All patients with unruptured abscesses with size less than 5 cms were given a trial of oral/IV anti-amoebic medications. Larger ones were drained under the cover of medications. Open surgical interventions were reserved for ruptured abscesses and for patients with toxic symptoms. Laparoscopic drainage was instituted for abscesses not responding to aforementioned conservative methods.

RESULTS
Mean hospital stay was 13.4 days with length of stay ranging from 2 to 35 days (S.D. 8.4 days). 100 patients were included in the study. Right lobe involvement was seen in 70% cases while left lobe was involved in 9% cases. Bilateral lobar involvement was seen in 5% cases. 22 patients had more than one ALA. 16% of patients presented with ruptured liver abscess where open surgical drainage was done. Eight patients were put on conservative treatment with intravenous metronidazole, of which, 4 patients responded well to conservative treatment while 4 patients failed to respond to treatment and their abscesses were aspirated. Aspiration along with antibiotics was performed in 76% cases as first line of therapy. Two patients who underwent emergency laparotomy for ruptured ALA, died.

CONCLUSIONS
Aetiology of LA in children has remained the same over the years, and in most regions, it is associated with Staphylococcus aureus and amoebic LA is quite uncommon. US or CT scan are the most frequently employed diagnostic modalities for LA, and follow-up is usually performed by serial US scans. Antimicrobial therapy along with drainage of the abscess by either percutaneous or open surgical route, if required remains the treatment of choice.

KEYWORDS
Amoebic, Liver Abscess