European Journal of Cardiovascular Medicine

Introduction: Liver abscess are more prevalent due to pyogenic, amoebic or mixed infection. Sometimes these may be fungal in origin. The primary mode of treatment is medical, but 15% of these may be refractory to medical   treatment. Percutaneous drainage continues to be the basis of care in these situations. For the purpose of curing sepsis, liver abscesses greater than 5 cm in size must be promptly drained.  In contrast, surgical drainage enables the rupture of multiloculi and the draining of viscid pus from large abscesses that are multiloculated or contain thick viscid pus. Our aim is to assess the effectiveness, success rate, clinical improvement, time required for complete abscess resolution, and length of hospital stay for patients undergoing USG guided pigtail catheterization vs. open drainage in the management of liver abscess. Materials And Method: After obtaining approval from institutional ethical committee this prospective study was conducted in 32 patients with liver abscess who admitted in surgery department of M.K.CG. MCH, Berhampur. On the basis of the clinical history, serologic testing (IgM Elisa), and inspection, followed by USG, a liver abscess was diagnosed. Standard investigations were conducted.. The patients included in the study were having non complicated abscesses with no features of rupture, no feature of impending rupture (liver tissue rim >1cm), no compression effect and abscess size >5 cm diameter. Patients who had multiple abscess cavities, ruptured or threatened abscesses, peritonitis symptoms and signs, and abscesses larger than 5 cm in diameter were excluded from the study.  Results: Mean age in group PD was 36yr while in group SD it was 35.9yr. There is male predominance in both the groups. A commonest symptom in both the groups was abdominal pain. Next common symptom was fever which was present in all patients of group PD and 13 patients in group SD. In both the groups (table 1) Haemoglobin and Liver function test was in normal range. Leucocytosis was present in 85% of cases and raised ESR in 90% of cases in both the groups. Volume of abscess ranged from 114 to 1200 ml 9. In group PD, success rate was 94.4 % while in group SD success rate was 100%. Total clinical improvement was seen in 4-8 days and 4-7days in Group PD and Group SD respectively. Time needed for total reduction was 5- 17 weeks in Group PD and 7-24 weeks in group SD. Hospital stay was 5-18 days and 6-21 days in group PD and SD respectively. Morbidity is 27% in group PD and 50% in group SD. Conclusion The conventional treatment for liver abscess is percutaneous catheter drainage (PCD), which is both safe and efficient. It leads to early symptom alleviation and quicker abscess cavity clearance. Surgery is an option for liver abscess drainage with concurrent intraabdominal pathology, multiloculated abscess with biliary communication, and failure of percutaneous drainage. PCD also has low morbidity and a good success rate, allowing it to be used as first line management in liquefied moderate sized abscesses.