European Journal of Molecular & Clinical Medicine

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. In recent years, imaging guided percutaneous drainage has been increasingly used to treat liver abscess of large size with viscous pus with reported success rates. Our study consists of clinical study (prospective study) of 40 cases of radiologically proven liver abscess and their management by different modalities and their outcome.
Materials& Methods: This is a hospital based prospective study done on 40 cases of radiological proven liver abscess in department of surgery at Government Medical College, Barmer, Rajasthan, India during one year period. USG abdomen was done, using longitudinal, oblique, transverse planes to visualize almost all part of liver. Intercostal and sub costal planes were used. All the liver lesions suggestive of liver abscess were examined in detail (any other abdominal organs were also scanned for any abnormalities). All the patients were hydrated and started on parenteral, third generation cephalosporins and Metronidazole therapy. All patients were simultaneously subjected to USG guided Needle aspiration.
Results: Our study showed that highest incidence (87.5%) of age is found between 3^rd- 6^th decades. Male predominance is always reported in literatures. Liver abscess is commonly seen in low socio-economic group. Ultrasound guided percutaneous needle aspiration was the initial mode of treatment done in our study. Out of 40 patients, 16 patients were successfully treated with single aspiration, 13 required second aspiration, 8 patients were treated with percutaneous catheter drainage after failure of needle aspiration.
Conclusion: Percutaneous needle aspiration is found to be thefirst line of treatment for liver abscess. This method is simple, effective and cheaper. Sinceliver abscess occurs in low strata group in a country like India this procedure is affordable.Percutaneous catheter drainage should be reserved as 2nd line of treatment for large abscesses andabscesses with thick viscous content and for failure of percutaneous needle aspiration cases.

Aim: Clinical and Biochemical Profile in Patients of Liver Abscess: A Study from
Tertiary Care Centre in Bihar.
Methods: This cross-sectional research was conducted. Patients who met the inclusion
criteria and provided written informed consent were chosen for the research after
authorization from the institutional ethics committee was obtained. All consenting
people above the age of 18. This research comprised patients who presented with
consistent symptoms of liver abscess and patients who were confirmed with liver
abscess radiologically (Ultrasonography and CT Scan, if necessary). Patients who
refused to provide permission for the research were omitted from the trial.
Results: Alcohol use was the most prevalent risk factor in our research, accounting for
50(50%) of the cases. Diabetes mellitus (DM) was shown to be another substantial risk
factor, accounting for 22% of all cases in the current investigation. Both risk factors
were present in 14% of the cases. The most prevalent symptom was abdominal pain (97
percent), followed by fever (95 percent ). The most prevalent per abdominal
examination finding was hepatomegaly (81%), followed by abdominal pain (73 percent
). Anorexia was discovered in 51% of the patients. As a result of the problems, 13% of
patients had right sided pleural effusion and 7% developed ascitis. Based on
biochemical measures, 81 (81 percent) of 100 patients exhibited TLC counts more than
11000/mm3. ALP levels were elevated in 97 percent of patients. In 75 individuals (75
percent), the INR was raised.

Liver abscess is a disease of frequent occurrence. Treatment modalities include both medical and surgical. However surgical drainage is the mainstay of treatment. With advent of ultrasound, percutaneous aspiration is becoming popular. Subjects from hospitals were grouped into those who underwent percutaneous aspiration and those who underwent pigtail catheter insertion. Both the groups are compared with the parameters like duration of hospital stay, duration to achieve symptomatic relief, duration of IV antibiotics required. A total of 106 subjects were studied. 52 of them underwent repeated percutaneous aspiration. 54 of them underwent pigtail catheter insertion. It is observed that pigtail catheter insertion is a better modality for larger abscess when compared to percutaneous aspiration in terms of duration of hospital stay, need for iv antibiotics and duration to achieve symptomatic relief.

Background&Method: Laparoscopic drainage of liver abscesses in combination with
systemic antibiotics is a safe and useful alternative in all patients who require surgical
drainage following failed medical or percutaneous drainage treatment and in those with
large abscesses. Operative techniques have started on intravenous antibiotics and the
laparoscopic procedure was performed under general anaesthesia with endotracheal
intubation. The patient was placed in the reverse Trendelenburg position and a
pneumoperitoneum was created with a veres needle to a pressure of 09-12 mm Hg.
Result: Pain in the right upper abdomen, fever and hepatomegaly were the most common
presenting features in 99.5% of patient. History of alcoholic intake leading to liver abscess
was 36%, while 36.84% of cases presented with mid jaundice. History of past dysentery was
34.21%. In the study by Abuabara etal(1982), the most common symptom of ALA was
Right upper abdominal pain (94%), fever (77%) and hepatomegaly(54%). In the study
by Charles etal(1989), the most common symptom was fever(70-80%), hepatomegaly
(56-65%), right upper abdominal pain (50%). Hematological investigation were carried
out in all patients the mean hemoglobin value was 10.1 gm/dL with a range of 5.0 gm% to
14.5 gm%. Leucocytosis, predominantly polymorphonuclear was observed, the mean
leucocyte count was 13,500 cells/cumm with a range of 5,500-32,000 cells/cumm. The
serum bilirubin was elevated in 60 (101) cases, the values ranging from 1.8-17 mg% with a
mean of 3.39 mg%. Hypoproteinemia was observed in majority of cases,the values ranging
from 4.8-8.9 mg/dl with a mean value of 6.47mg/dl.
Conclusion: In summary , the most common presenting features were Fever,
Hepatomegaly, with males in the age group 41-50 being mostly affected. Right lobe
involvement (singly) with raised dome of diaphragm were seen most commonly on
radiological investigations. PLA should be treated with broad spectrum antibiotics and
in abscesses larger than 2.5 cm, aspiration should be done. Operative intervention is
required for intra-abdominal infections that are seeding the liver abscess.