A comparative study of liver abscess: therapeutic aspiration verses continuous catheter drainage

Background: Previously liver abscesses were treated primarily by surgery but with advances in imaging techniques the trend is changing towards use of potent antimicrobials and minimally invasive ultrasound guided interventional procedures and surgery is being done only in selected cases. We conducted this study to find out the feasibility, limitations, effectiveness, outcome and complications of therapeutic needle aspiration and continuous catheter drainage of liver abscess.Methods: This was a hospital based randomized control prospective study in which patients with liver abscess were included. 100 patients of liver abscess selected by simple randomization to 2 groups namely Group A (needle aspiration) or Group B (continuous catheter drainage) undergo the above two interventional procedures. For statistical purposes P value less that 0.05 was taken as statistically significant.Results: This study consisted of 100 patients out of whom there were 78 (78%) males and 22 (22%) females with a M:F ratio of 1:0.28. Single hepatic abscess (75%) was more common than multiple abscesses (25%) and pyogenic abscess (67%) was more common than amoebic abscess (33%). Right lobe of liver was most commonly involved (61%) followed by left lobe (22%). All patients in both the groups were treated successfully and there was no treatment failure in any of the groups.Conclusions: Therapeutic needle aspiration as well as continuous catheter drainage both are equally effective in management of liver abscess but needle aspiration had the advantage of being less expensive, easily available and requiring less hospital stay.

Clinicopathological study on presentation, diagnosis and management of liver abscess in Bhopal region

Background: This prospective observational study is carried out to study cases of liver abscess and to determine demographic profile, spectrum of clinical presentations, aetiology, laboratory investigations. The objective of the study was to evaluate efficacy of Ultrasonographic (radiological) studies in determining the aetiology and in differentiating from other liver pathologies which may change the treatment outcome, bacteriological and serological characteristics, to study the influence of alcohol, diabetics and immunocompromised diseases (esp. HIV) leading to increased incidence of liver abscess and to evaluate efficacy, recurrence rate, complications, morbidity and mortality, duration of hospital stay associated with different management Strategies.Methods: This prospective observational study was carried out in Department of Surgery, Gandhi Medical College Bhopal and Associated Hamidia Hospital, Bhopal between July 2015 to October 2016.Results: Amoebic abscess (74%) is more common than pyogenic abscess (26%). Amoebic abscess is common in the age group of 31-50 years (73%), pyogenic in the age group of 51-70 years (73.1%). Male preponderance is found in case of amoebic liver abscess (90.5%). Right lobe involvement in common. Right upper quadrant pain, tenderness and fever are the most common clinical features. Alcoholism is most common risk factor (71.6%) and diabetes mellitus has strong association with pyogenic liver abscess (15.4%). E coli (19.2%) and klebsiella (11.5%) are the most common organisms cultured. Medical therapy is more useful in case of amoebic liver abscess (58.1%) while catheter drainage is more useful in case of pyogenic liver abscess (61.5%). Pleuropulmonary complications are much more common and complications rate is more common among pyogenic group.Conclusions: In our study, alcohol was found to be the most common predisposing factor for liver abscesses (68%), this underpin the finding of other studies. Amoebic liver abscess is a medically treated common infection prevailing in unhygienic condition, affecting people mostly between 30-40 years of age whereas pyogenic liver abscess patient commonly falls between 50-70 years age group. Both liver abscesses show a male preponderance. The present study also corroborates the catheter drainage procedure as a superior modality in treating pyogenic liver abscess.

Morphological Findings in Trophozoites during Amoebic Abscess Development in Misoprostol-Treated BALB/c Mice

During amoebic liver abscess (ALA) formation in susceptible animals, immune response is regulated by prostaglandin E2(PGE2) dependent mechanisms. The aim of this study was to analyze the effect of misoprostol (MPL), a PGE1analogue, on ALA formation in BALB/c mice. Male mice from BALB/c strain were intrahepatically infected with7.5×105trophozoites ofE. histolyticastrain HM1:IMSS and treated with 10−4 M of MPL daily until sacrifice at 2, 4, and 7 days postinfection (p.i.). ALA formation was evaluated at 2, 4, and 7 days postinfection; trophozoite morphology was analyzed using immunohistochemistry and image analysis. Results showed an increase in frequency of ALA formation in infected and MPL-treated mice only at 2 days p.i. (P=0.03). A significant diminution in the size of trophozoites was detected in abscesses from mice independently of MPL treatment (from5.8±1.1 µm at 2 days p.i. to2.7±1.9 µm at 7 days p.i.) compared with trophozoites dimensions observed in susceptible hamsters (9.6±2.7 µm) (P<0.01). These results suggest that MPL treatment may modify the adequate control of inflammatory process to allow the persistence of trophozoites in the liver; however, natural resistance mechanisms cannot be discarded.