Management Strategies and Clinicopathological Evaluation of Liver Abscess in the Tribal Area: A Cross Sectional Study

Abstract

Background: Liver abscess continues to be disease with considerable mortality in our country especially in Tribal Area. Locally made alcoholic drinks like neera, arrack may be the routes of faeco-oral transmission of amoebic cysts. Hence the aim of the study was to study the influence of alcohol, diabetics & immunocompromised diseases leading to increased incidence of Liver abscess and to evaluate efficacy associated with most effective treatment. Subjects and Methods: The present study included 50 patients diagnosed with liver abscess. All the patients were under the treatment for the period of years. All cases of liver abscess diagnosed clinically and/or ultrasonographically, all cases of bacterial and parasitic liver abscess and the cases in evolving, liquefied & ruptured stage with or without peritonitis were included in the study. Results: When the management part of the liver abscess was analysed 14 patients had abscess that was less than 200 cc or had multiple small abscess involving both lobes that were managed conservatively. Total of 36 patients who had abscess > 200 cc or left lobe abscess were subjected to intervention, of which 24 patients were treated with percutaneous aspiration with antibiotic coverage, 6 patients were treated with laparotomy procedure and 4 patients treated with drainage with laparoscope and 2 patients underwent ICD insertion. Conclusion: Liver abscess is a common condition in tribal area of India. It is still, a disease associated with considerable morbidity. Intraperitoneal rupture, pleural rupture, septicemia are the conditions that can occur. Multiple small liver abscess and solitary liver abscess < 200 cc or size < 5cms can be successfully managed with conservative line of management with antimicrobials / antiamoebic drugs, but recurrences were noted. Percutaneous needle aspiration as well as Pigtail Catheter insertion is safe and highly effective method of managing liver abscess cases. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.