Dr Wajeeha Fatima, Dr Abdullah Rehmat, Dr Amir Ali
Aim: To analyze the diagnosis, treatment, predisposing factors and treatment outcomes in patients with liver abscess. Study design: A prospective cross-sectional study. Place and duration: In the Department of Surgery Unit II and the Pathology Jinnah Hospital Lahore for one-year duration from April 2019 to April 2020. Methodology: A total of 55 patients with liver abscess, 44 men and 11 women, aged 18 to 65 years, with an average age of 35 years. Diagnoses were based on fever, anorexia, malaise, abdominal pain, hepatomegaly, leukocytosis, elevated ESR, elevated liver enzymes, and ultrasound features of liver abscess. All patients were given parenteral antibiotics. People with a single abscess larger than 5 cm underwent percutaneous transhepatic drainage under ultrasound guidance and the size of the abscess and its resolution were monitored. In case of improvement, antibiotics were given for 4 to 6 weeks. Patients who did not respond to the above treatment had complications and were selected for surgical drainage. Results: Out of 55 patients, 43 had single and 12 multiple abscesses, 37 patients had an abscess of the right lobe, 6 patients had an abscess of the left lobe, and the remaining 12 patients had multiple abscesses involving both lobes of the liver. Concomitant diseases were observed in 15 patients and 3 patients were opium addicted. The most common symptom was fever, followed by abdominal pain, liver enlargement, and weight loss. 31 (51%) bacteriological cultures were positive for aspirated pus. The most common organism was E. coli. In 15 patients, the serological test for entamoeba histolytica was positive. Polymicrobial infection detected in 9 cases. In 12 patients with an abscess smaller than 5 cm, only antibiotic therapy was effective, 2 patients did not respond and were aspirated. US guided percutaneous needle aspiration (PNA) performed in 31 patients (60%), 20 of whom required repeated aspiration and 11 required surgical drainage. Seven patients died from various causes. Three patients had a recurrence of the liver abscess; wound infection occurred in 5 patients. In 34 patients it was defined as cryptogenic. Fifteen cases were diagnosed as amoebic. Conclusion: Needle aspiration is an easy, fast, safe and effective method of treating liver abscess. Surgery should be limited to those cases where needle aspiration does not cure the disease, abscess rupture, concomitant pathology, or multiple abscesses. Keywords: liver abscess, antibiotics, percutaneous needle aspiration, ultrasound conduction, surgical drainage.