Liver abscess: diagnostic and management issues found in the low resource setting

Khim, Gaetan; Em, Sokhom; Mo, Satdin; Townell, Nicola

doi:10.1093/bmb/ldz032

Cited by 83 publications

(128 citation statements)

References 26 publications

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“…The clinical presentation of both amoebic and PLA is indistinguishable. Patients usually present with fever and right upper quadrant tenderness [8]. Objectives of our present study was to evaluate the aetiology, clinical profile, management and prognosis of liver abscess patients.…”

Section: Introductionmentioning

confidence: 98%

Clinical Profile of Liver Abscess: A Hospital Based Prospective Study.

Pradhan

Amit

Singh

2020

IJMBS

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Objectives: Liver abscess (LA) is defined as collection of purulent material in liver parenchyma which can be due to bacterial, parasitic, fungal, or mixed infection. The liver abscess is mainly classified into amoebic and pyogenic. This present study was to evaluate the aetiology, clinical profile, management and prognosis of liver abscess patients. Methods: A detail history, clinical examinations and relevant investigations were performed to all liver abscess patients. Investigations was performed like as routine blood investigations, chest x-ray, PA view, X-ray abdomen, AP view, ultrasound abdomen, CT scan abdomen (if needed). Culture and sensitivity of the aspirate was performed. Results: Data was analysed by using simple statistical methods with the help of MS-Office software. Conclusions: Liver abscess was commonly seen in elderly age groups. Male was more preponderance than females. Amoebic liver abscess was commonly found. Amoebic liver abscess was commonly seen in alcoholic patients. Abdominal pain, fever and abdominal distension were common clinical symptoms. Tenderness on right hypochondrial, intercostal region and hepatomegaly were the common clinical sign of liver abscess. Abscess was mostly seen in right lobe than left lobe. Most of the patients were managed by percutaneous single aspiration. If aspiration was failed, percutaneous catheter drainage was the choice for management of liver abscess. Hence, A very prompt recognition is important in instituting effective management and achieving good outcomes. Because of the nonspecific symptoms and laboratory findings, the presence of predisposing factors can be helpful in increasing the level of diagnostic suspicion. The key to successful outcome in the management of liver abscess is early diagnosis and appropriate therapy. Keywords: Liver abscess, age group, amoebic liver abscess, pyogenic liver abscess, alcoholic, management of liver abscess

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Section: Introductionmentioning

confidence: 98%

Clinical Profile of Liver Abscess: A Hospital Based Prospective Study.

Pradhan

Amit

Singh

2020

IJMBS

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“…Liver abscess usually presents subacutely with nonspecific signs and symptoms. Most common symptoms are fever, right upper quadrant pain, hepatomegaly and jaundice associated with decrease of appetite and weight loss [3].…”

Section: Discussionmentioning

confidence: 99%

“…Antimicrobials, interventional radiology or surgical drainage can be used, combined or as a single therapy. However, the combination of drainage with antibiotics has shown better outcomes in hospital stay, morbidity, fatality and complications [3]. Continuous catheter drainage is most commonly used technique for draining PLAs, while intermittent needle aspiration can also be used with comparable outcomes [6].…”

Section: Discussionmentioning

confidence: 99%

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Multiloculated Liver Abscess Caused by Fusobacterium: Role of Karius Testing in Diagnosis

Zafar¹,

Rashid²,

Mandzhieva³

et al. 2020

Cureus

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Pyogenic liver abscess can be a major diagnostic and therapeutic challenge despite advances in cutting edge technologies. A patient presented with fever, right upper quadrant pain and diarrhea. CT revealed multiple hypodensities in both lobes of liver. The largest lesion was in the left lobe of liver and was multiloculated with thick septations. The causative organism was identified to be Fusobacterium nucleatum by Karius testing. The patient was discharged on six weeks of ertapenem therapy, which resulted in complete resolution. This is the first case of liver abscess where Karius testing was used to identify microorganism. It also highlights that multiloculated and difficult to drain liver abscesses caused by highly sensitive organisms can potentially be treated by intravenous antibiotics alone in immunocompetent patients.

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“…Pyogenic liver abscess (PLA) is important cause of hospitalization and life threatening disease in low-middle income countries [ 6 , 18 ]. Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

et al. 2020

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Background Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management. Clinical spectrum of GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Up to now, GFPLA has not been well studied in Vietnam. Case presentation We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 41-year-old man with a history of treated duodenal ulcer and uncontrolled type II diabetes mellitus. He had an epigastric pain associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a 4 cm × 4 cm pus-containing abscess in the left liver lobe of the liver. The abscess was ruptured. Pus was running into abdominal cavity through one hole. The abscess and abdominal cavities were cleaned up and abscess and abdominal drainages were performed. K. pneumoniae was isolated from culture of the abscess. The histopathological examination of the abscess did not yield any evidence of malignancy. Blood glucose levels were controlled. Antibiotic therapy was used according to antibiogram. A reassessment chest X-ray showed no air-fluid level or subdiaphragmatic air by the hospital day 14. Patient eventually made a full recovery and was discharged home 23 days after the operation. Conclusions Ruptured GFPLA is a life-threatening complication. It is usually accompanied by peritonitis and pneumoperitoneum and can imitate hollow viscous perforation. In these cases, CT scan should be performed whenever it is possible to make a correct diagnosis. When the abscess has small size, partial hepatectomy might not be necessary and could be replaced by a careful cleaning and drainage of the abscess. Patient could show a good postoperative recovery following an appropriate antibiotic therapy.

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Liver abscess: diagnostic and management issues found in the low resource setting

Cited by 83 publications

References 26 publications

Clinical Profile of Liver Abscess: A Hospital Based Prospective Study.

Clinical Profile of Liver Abscess: A Hospital Based Prospective Study.

Multiloculated Liver Abscess Caused by Fusobacterium: Role of Karius Testing in Diagnosis

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

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