Hepatic Abscess- Management and Outcomes at Tertiary Care Centre, Garhwal, Uttarakhand, India

Introduction: Liver is the commonest organ prone to develop an abscess. Encountered in tropical and developing countries, this poses diagnostic/therapeutic challenges, and has significant associated morbidity. Hepatic abscess patients of varied aetiology commonly present in this setup at an advanced disease stage and warrant prompt recognition and remediation. Aim: The aim of the study is to depict, analyse management and outcome aspects of hepatic abscesses at the Tertiary Care Center in Garhwal, Uttarakhand, India. Materials and Methods: Hepatic abscess patients who presented and were managed between August 2015 and August 2019 at VCSGGMS & RI-UT were included in this observational descriptive study. Appropriate directed antimicrobial therapy was administered to all cases. Post-resuscitation and evaluation based upon the indication and surgeon’s preference, Percutaneous Needle Aspiration (PNA) or percutaneous USGguided Pigtail Catheter Drainage (PCD) done, while exploratory laparotomy/Surgical Drainage (SD) done for complications. Results: Seventy patients (Total=70; 58 males=82.8%) presented with hepatic abscess, out of which 40 (57.1%) needed in-hospital treatment for severity of symptoms. PNA was done in 25 patients (35.7%), with nine (12.8%) required multiple aspirations, PCD done in seven (10.0%) and eight (11.4%) had to undergo exploratory laparotomy/SD among the 40 Inpatient Department (IPD) treated patients. Patients in this setup had a higher number of Pyogenic Liver Abscess (PLA) (48 of 70=68.6%), with E.coli predominating (26, 37.1%), than Amebic Liver Abscess (ALA) (n=17, 24.3%); most being solitary cavities (40, 57.1%), confined to the right lobe (33, 47.1%). Alcoholism (34.3%) and hypoalbuminemia (64.3%) were associated with development as well as delayed resolution of the abscess. While seven patients required repeat interventions, most gained relief from the primary treatment modality (53, 75.7%), assessed on follow-up. Conclusion: Antibiotics and multi-modality image-guided percutaneous management resolved most hepatic abscesses. Surgeon and intervention radiologist collaboration recommended.