Sohini Sengupta1 , Barindra Nath Mallick2 , Mainak Ghosh3 , Sanjay Kumar Bhagat4
BACKGROUND Liver abscess is a serious medical condition with high mortality if left untreated and known to respond favourably to surgical drainage with appropriate antimicrobial therapy. With advancements in imaging, percutaneous ultrasoundguided aspiration and drainage has emerged as a less invasive modality for abscess management. We wanted to study the clinical improvement, complications and duration of hospital stay after catheter drainage of liver abscess under ultrasound guidance, re-assess the size of abscess cavity and determine the aetiology of liver abscess wherever possible. METHODS Data was collected from 30 patients with liver abscesses attending a tertiary care hospital with inputs from the departments of Radiology, Surgery and Medicine. The patients were subjected to ultrasound guided catheter insertion for pus aspiration and drainage after written informed consent was obtained and preprocedure workup was medically acceptable. The patients were followed up in hospital till they were cured, or they developed complication necessitating further care. RESULTS Liver abscess was more common in young adult age group (21-40 yrs.) with a male to female ratio of 28:2. Right lobe of liver was more frequently involved compared to left lobe. Fever was the most common presenting symptom followed by pain. Most of the cases did not show growth of any microorganism, either due to empirical antimicrobial therapy or due to amoebic aetiology. Among the positive cases, E. coli was the most common causative organism. Volume of the abscess cavity ranged from 400 to 2000 cc with a mean of 805 cc. Catheter blockage and dislodgement were rarely reported in our patients. The mean duration of drainage was 14 days (range 7-29 days). No death occurred during treatment or follow up with a success rate of 93%. The non-availability of microbiological confirmation of amoebic and anaerobic aetiology in our institution during our study period was a limitation. CONCLUSIONS Ultrasound guided percutaneous pigtail catheter drainage is a safe, cost-effective and radiation-free mode of treatment of both amoebic and pyogenic liver abscesses with low morbidity and high success rate. This therapy should be the first line of management in liquefied moderate to large sized liver abscesses.
