Clinico-pathological Profile of Pyogenic Liver Abscess: An Experience from Tertiary Care Hospital from Kashmir Valley

Introduction: Liver abscess is not an uncommon surgical problem seen in day to day clinical practice. It is an important and potentially curable disease entity. It is difficult to diagnose it clinically but is potentially curable, if treated well and reduces morbidity and mortality considerably. The formation of hepatic abscess is related to two distinct groups of pathogens - the pyogenic bacteria and the Entameoba histolytica. Liver abscess is associated with mortality of up to 20%. Surgical drainage of pyogenic liver abscess was the commonest and best accepted modality of treatment in past. Now it is being replaced by minimal access surgical techniques like image guided percutaneous drainage and laparoscopic drainage procedures, but open surgical drainage is still applicable in cases, where the abscesses are secondary to biliary pathology, where percutaneous drainage fails and where abscess has ruptured.

Aims and Objectives: The aim of our study was to evaluate, the various causes of pyogenic liver abscess, commonest micro-organism, various diagnostic modalities in diagnosing pyogenic liver abscess, to evaluate conservative treatment and surgical treatment, and to establish various guidelines for particular therapeutic procedure.

Materials and Methods: The present study entitled “Clinico-pathological profile of pyogenic liver abscess” was conducted in the Department of Surgery SMHS (Shri Maharaja Hari Singh) Hospital Srinagar Kashmir from April 2011 to April 2014. Our study was conducted on 100 patients and following observation was made.

Results: In our study, the maximum age was 67 years and minimum was 6 years. The most common presenting symptom was fever (98%) followed by abdominal pain (76%), and most common sign was fever (98%) followed by right upper quadrant pain (69%).74% of patients have hemoglobin <10 gm. % and 36% had leucocyte count < 10, 000/ cumm. Blood culture was performed in 72 patients and only 51(70.83%) reports came with positive microbial report and pus culture was performed in 80 patients and 69 (86.25%) reports came with positive microbial report. The most common organism grown in blood culture was E. coli (Escherchia coli) 33.33%, Klebseilla 29.41% and in pus culture was E. coli 36.23%, followed by Klebseilla 27.53%.USG done in all patients showed right lobe abscess in 72%, left lobe in 21% and in both lobes 7%, single abscess cavity in 75% and multiple cavities in 25% of patients. CT Scan done in 57 patients showed Right lobe abscess in 64.91 %, left lobe abscess in 28.07 and in both lobes in 7.01%. The various modalities of treatment adopted in our study of 100 patients were open surgical drainage in 21, Percutaneous needle aspiration drainage in 17, percutaneous catheter drainage in 20 and Laparoscopic drainage in 20 and conservative management with intravenous antibiotics in 22 patients. The most common post-operative complications of open surgical procedure was thrombophlebitis in 66.66%, pleural effusion in 23.80%, and in non-surgical procedure complications were thrombophlebitis of superficial veins, repeated aspiration and pleural effusion, in 28.07%, 12.28%, 8.77%, 5.26% respectively.

Conclusion: Liver abscess is a fatal disease if early diagnosis and proper treatment is not initiated. Early recognition of clinical features and proper investigation including abdominal USG is very important. Our experience with patients of percutaneous needle aspiration under USG guidance is helpful, and cost-effective for multiple or solitary abscesses of less than 10 cm. Percutaneous needle aspiration under USG guidance is combined with administration of systemic antibiotics and metronidazole. Patients treated by this technique recover faster and duration of hospital stay is less.