Percutaneous drainage may not be necessary in a significant subset of patients with complicated liver abscess

Abstract

Background: Clinical features and outcomes of liver abscess are ever changing, even in South Asia, where parasitic infections are common. It is important to devise management strategies to suit the changing needs. We wanted to capture this emerging spectrum in "real life" through assessment of clinical features, management strategies and outcomes of a cohort of treated liver abscess patients at a single center. Methods: A retrospective study of patients admitted to a referral institution between February 2010 and June 2014 was undertaken. Patients with liver abscess who have received prior treatment in another hospital, and have then been referred for a complicated disease course were studied; their demographics, clinical presentations, evolution and outcomes were analyzed. Results: A total of 154 patients [males 109, 70.78%), mean age 43.71 ±16.49 years] were included in this study. Alcohol use was the most common (23.38%) predisposing factor, followed by biliary obstruction (20.78%) and diabetes (11.04%). Most common presenting features were fever, pain abdomen and jaundice [92.9%, 86.4% and 20.8% patients respectively]. Majority of patients (58.4%) had a solitary liver abscess; right lobe being the commonest site(61%). Median abscess volume was 180 ml (Range 7-1524 mL); abscess rupture occurred in 21 (13.6%) cases, most commonlyin subdiaphragmatic location. Overall, abscess drainage was required in 97 (63%) patients [single time aspiration 15 (15.5%), percutaneous indwelling catheter 80 (82.8%), surgical drainage 2 (2.1%)]. Patients who required percutaneous drainage were mostly males, had higher abscess volumes and were more frequently alcohol users and diabetics. Six (3.9%) patients died in the study period. Conclusion: While large abscess, alcoholism and diabetes were associated with increased need for catheter drainage, 37% can be treated by drug therapy alone. Careful selection of subjects for drainage may help in decreasing the mortality rate in this benign condition.

Liver abscess: study of etiological factors and different treatment modalities and their clinical implications

“…Twenty four (24%) and 62 (62%) patients were occasional and frequent drinkers while 14 (14%) patients did not drink alcohol. This is comparable to the studies of Choudhary et al and Saptarshi et al 15,18 Choudhary et al study identified the clinical profile of liver abscess reported alcohol was the single most consistent etiological factor in 84% patients of liver abscess. 19 Saptarshi et al study reported possible risk factors identified were alcohol use in 36 (23.4 %) patients, biliary obstruction in 32 (20.8%) and diabetes in 17 (11%) patients.…”

“…17 In the present study, 4 (4%) patients died while 96 (96%) patients survived; 3 (3%) patients had undergone surgery while 1 (1%) patient was percutaneously drained. This is comparable to the studies of Saptarshi et al and Jha et al 17,18 Saptarshi et al, study reported surgical intervention in 2 (1.30%) patients. Mortality rates among liver abscess patients stood at 3.9%.…”

“…No risk factors could be attributed in 61 (39.6%) patients. 18 Jha et al study determined etiopathology, clinical, radiological, and bacteriological characteristics of the condition and review its management strategies reported of 110 patients with ALA 15 patients were treated with medical or conservative treatment with a success rate of 70%, 37 patients was treated with percutaneous needle aspiration with a success rate of 67%, 37 patients were treated with percutaneous catheter drainage and the success rate of this procedure was 100%, and 21 patients presented with features of peritonitis, were treated with surgical exploration and drainage. The success rate in this group was 65%.…”