A study of the different treatment modalities used in the management of amoebic liver abscesses

Garale, Mahadeo; Takalkar, Yogesh; Ingale, Parag R.

doi:10.18203/2349-2902.isj20163156

Cited by 1 publication

(2 citation statements)

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“…While metronidazole has remained the cornerstone of management of ALA since its acceptance, various studies have demonstrated early recovery with drainage of the abscess. 6 8 9 15 16 In the later stages ALA usually consists of acellular proteinaceous debris, and a brown fluid which is likened to “Anchovy Paste” consisting of necrotic hepatocytes. A 10 Fr pigtail catheter becomes nonfunctional due to blockage which may require repeated flushing which in turn can introduce secondary infections.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of biliary communication was 22% in the present study which is similar to that reported in existing literature. 4 6 16 The presence of biliary communication was associated with the need of a longer duration of hospital stay. These patients also had a larger abscess, were more frequently associated with jaundice, and required catheter drainage for a longer duration.…”

Section: Discussionmentioning

confidence: 99%

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Enhanced Drainage Protocol in Large Amoebic Liver Abscess

Gandhi

Shinde²,

Chaudhari³

et al. 2021

Surg J (N Y)

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Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p-value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p-value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p-value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

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