Publication:

Audit of patients with ruptured amoebic liver abscess and outcome of surgical versus non-surgical treatment

Background Amoebic liver abscess (ALA) is a common infection caused by parasite Entamoeba histolytica and is one of the leading causes of death in tropics. 10% of world population is infected with E. histolytica. It is highly endemic in India. This is a retrospective observational study conducted from July 2011 to November 2013. Aims and objectives are to study (1) Demographic, clinical features, treatment given and outcomes. (2) Compare outcome between surgical versus non-surgical methods (3) Assessing the complications of ruptured amoebic liver abscess.

Methods Retrospective observational study of patients with ruptured amoebic liver abscess presenting to our institute (a tertiary referral centre). Details of demographics, clinical features, imaging findings were recorded. Also details of procedure, complications and outcome of surgical or non-surgical methods were recorded. Univariate analysis will be done applying ‘t’ test. Data will be analyzed using SPSS software.

Results Pain in abdomen and tenderness was the most common presentation of patients (100% cases). Right lobe of liver was involved in 83.3% cases. Pigtail catheter drainage was the most common treatment modality given to patients (63.3% cases). Following rupture, pleural effusion was the most common complication noted in our study. Common sites for perforation include pleural cavity or bronchial tree (72%). The mean duration of stay in ward was 9.8 days. Zero percent mortality in patients who received non-surgical treatment compared to 40% mortality in patients treated surgically (2 out of 5).

Conclusions This study concluded that there is significant mortality in patients of ruptured amoebic liver abscess all associated with surgical intervention compared to non-surgical measures. Surgery is reserved for cases of generalized peritonitis or of superadded infections not responding to non-surgical measures with guarded prognosis.