Clinical Presentation and Outcome of Liver Abscesses

Introduction: Liver abscess is a burning problem of tropical countries and remains a formidable diagnostic and therapeutic problem. If left untreated, the disease invariably runs a lethal course. No differentiation can be made between pyogenic and amoebic liver abscess on the basis of clinical features, laboratory findings and radiological features. This study was designed to analyze the diagnosis, management and outcome of patients admitted with liver abscess. An attempt has been made to assess the outcome of using the total leucocyte count at presentation as a criterion for deciding the choice of antibiotics. A prospective Materials & Methods: observational study was conducted. Detailed history & examination of patients were recorded on a proforma. Blood sample was taken for routine investigations, liver function test, PT/INR, blood culture and serological testing for Entamoeba histolytica antibodies. The location, number, and size of the abscess or abscesses were noted. A single abscess of more than 3 cm in diameter, or, multiple abscesses where the largest was more than 3 cm in diameter, was aspirated under ultra-sonographic guidance. The pus was sent for microbiology for wet mount examination of E histolytica and culture sensitivity for bacteria. Thirty volunteers who were age and sex matched were used as controls for serological testing for E histolytica. For management, patients having a TLC of more than 12000/mm3 were treated with IV Vancomycin and IV meropenem covering Staphylococcus aureus or Gram-negative organisms respectively, along with IV metronidazole. If no organism was cultured the antibiotics were given for 7 days. Patients having TLC of less than 12000/mm3 were treated as amoebic liver abscess and given IV Metronidazole 750 mg every 8 hourly or oral metronidazole 800 mg every 8 hourly for 10 days, depending on whether he could tolerate oral drugs. Patients were monitored for response. Ninety percent of patients had abdominal pain, fever & loss of appetite at the time of pre Results: sentation. >70% had abdominal tenderness & hepatomegaly. >80% patients had raised TLC & 76% had raised bilirubin levels. Eighty percent of patients with raised TLC responded well to IV antibiotics and IV metronidazole, while 20% required percutaneous drainage. In the group with normal TLC, 60% responded to metronidazole alone, with 40% necessitating additional antibiotics or percutaneous drainage. Patients were called for follow up after 7 days and 30 days of discharge. Two patients required readmission during follow-up. They were managed using antibiotics and pigtail drainage. 1 patient died in ICU due to acute MI.