Etiology and clinical presentations of liver abscess in a tertiary care hospital, impact of various factors on outcome in patients undergoing percutaneous drainage versus patients on conservative management for liver abscess

Background: A liver abscess is defined as pus-filled mass in the liver that can develop from injury to the liver or an intraabdominal infection disseminated from the portal circulation liver abscess is caused by agents such as Entamoeba histolytica, Escherichia coli and Klebsiella pneumonia, staphylococcus aureus, streptococcus pyogenes, enterococcus faecalis. Clinical presentation of liver abscess include right upper quadrant pain, fever, cough, malaise, weight loss, anorexia, Jaundice, and abdominal pain with hepatomegaly. The diagnosis of liver abscess is made by radiographic imaging of the liver, stool microscopy, evaluation of liver abscess fluid, amoebic Serology.USG and (CT) scan are the diagnostic modalities used for identification of liver abscess. Treatment of liver abscess were antibiotic, antiamoebicand USG-guided percutaneous pig tail catheter drainage. Materials and Methods: This was a prospective observational study conducted in tertiary care centre in north india over a period of one year. Data was collected on a structured questionnaire by interview method from patients admitted in wards, intensive care unit of the family medicine department fulfilling inclusion and exclusion criteria. Patient with age greater than 18 years of age with clinical features, laboratory investigations, and ultrasound evidence of liver abscess were included in study written informed consent from patient was obtained. Pregnant females, Concomitant biliary tract malignancy, uncorrectable coagulopathy were excluded from study. Results: A total of 101 hospitalized acutely ill medical patients, who met the inclusion criteria were selected for study. Patients were prospectively followed till the discharge from hospital. To study the etiology and clinical presentation of liver abscess in a tertiary care hospital, Impact of various factors on outcome in patients undergoing percutaneous pigtail catheter drainage versus patients on conservative management for liver abscess were analysed. In our study 95 patients (94.05%) out of 101 patients had complaints of abdominal pain. Most common agents seen inpyogenic liver abscess was Klebsiella pneumoniae, Escherichia Coli, on analysis of data of 91 patients (90.09%) out of 101 patients. Time taken for clinical improvement with conservative medical management is 17.18 day whereas time taken for clinical improvement with pig tail catheter drainage were 13.38 days. Duration of stay was more in medical treatment(17.18±2.92) as compared to percutaneous catheter drainage(13.38±1.63), p=0.001 Conclusion: In our prospective observational study we found that patient who underwent percutaneous catheter drainage had better outcomes compared to conservative medical management. Early intervention with Percutaneous catheter drainage reduces average length of hospital stay and improves recovery.