CLINICAL PROFILE, DIAGNOSIS AND THERAPEUTIC MANAGEMENT OF PYOGENIC LIVER ABSCESS

Introduction:Liver abscess comprises 48% of all the visceral abscesses.Liver abscess is broadly divided into amoebic and pyogenic liver abscess with majority of the amoebic etiology in developing countries and pyogenic in developed countries. Early detection and localization secondary to advancements in CT and ultrasonography (US) advanced the treatment of pyogenic liver abscess considerably. Nowadays percutaneous treatment of pyogenic liver abscess whether single or multiple abscesses has become the standard of care. In addition, endoscopic and laparoscopic option for drainage in patients who are not responsive to antibiotic treatment have been explored with good outomes. Results: In our study, mean age of patients was 46.37 +- 17.93, Our youngest patient was 19 years of age and elder most was 80 years of age. 53.33% (24) patients were males and 46.67% (21) were females. 37 (82.22%) had high-grade fever. Majority i.e., 15/45 patients (33.33%) showed growth of Escherichia coli after 48 hours of inoculation. Streptococcus was other major group, growth was present in 24.44% of patients, in ten out of 45 patients (i.e., 22.22%), no growth was seen after 48 hours of inoculation. Klebsiellas and staph aureus was seen in five (11.11%) and four (8.89%) patients respectively. Majority 23/45 of our patients were managed by pigtail drainage i.e., 51.11%. 17/45 patients were managed by IV followed by oral antibiotics making this category of patients 37.77% of our total sample population. Open surgical drainage was done in four patients (8.88%), two out of them were directly taken for surgical intervention and other two after failure of pigtail drainage. Only one patient had to undergo Usg guided pigtail drainage after failure of IV antibiotic therapy. Conlusions: Hepatic abscesses are a relatively rare occurrence, but an important health problem nonetheless. Slight male preponderance as compared to female population. Percutaneous catheter drainage is safe and effective treatment option than minimal invasive/open surgical procedure, and is the most reliable and effective means of management.