CLINICO PATHOLOGICAL PROFILE AND MANAGEMENT OF PYOGENIC LIVER ABSCESS

Abstract

Background: Pyogenic liver abscess is a commonly encountered disease of Hepato-biliary system with high morbidity and mortality if not recognised early.

Study Design: Retrospective and prospective observational study.

AIMS: To study the Clinico-pathological profile, microbiological characteristics, role of percutaneous drainiage and role of Surgery in Pyogenic liver abscess.

Material and Methods: The present study of Clinico- pathological profile of pyogenic liver abscess included 160 patients, 120 retrospective and 40 prospective, from Aug 2010 to 2017 and Aug 2017 to Aug 2019 respectively.

Results: The maximum patients were seen in the fourth decade of life, with males outnumbering females. Fever was the most common complaint in 78.12% patients, followed by pain abdomen in 63.12 % patients. The commonest sign on examination in our study was right upper quadrant tenderness seen in 68.75 % patients, followed by hepatomegaly in 43.75% patients. The most common laboratory abnormalities were increased ALP in 87.5% patients followed by increased WBC count in 62.5% patients. Coagulation profile was deranged with increased PT in 56.87 % patients. Blood culture was positive in 40 % patients and Klebsiella was the most common organism isolated i. e in 56.25 % patients, followed by E. Coli in 37.5% patients. Pus culture revealed klebsiella and E-coli most common organisms. The present series showed about 55% of the total abscesses were cryptogenic in origin, while 23, 10, 8 and 2% were due to biliary, hematogenous, malignancy and iatrogenic causes including Liver Biopsy respectively. Ultrasonography was the mainstay of diagnosis and was done in all patients. CT scan was helpful in localising the abscess accurately. Majority of the patients had solitary abscess in about 62.3% patients with the most common lobe being the right lobe. The most common treatment modality was pigtail drainage of abscess and was done in 80 percent patients, followed by percutaneous aspiration and intravenous antibiotics. Surgical drainage was done in four patients who presented with ruptured abscess. . Malignancy and diabetes mellitus were poor prognostic factors detected.

Conclusion: Pyogenic Liver abscess is associated with relatively high mortality and morbidity, and several serious complications and a very prompt recognition is important in instituting effective management and achieving good outcomes.