Outcome with and without Aspiration of the Amoebic Liver Abscess at Civil Hospital, Karachi

Abstract

Objective: To compare the outcome with and without aspiration of the amoebic liver abscess.

Study Design: Comparative study

Place and Duration of Study: This study was conducted at Medical Wards of Civil Hospital Karachi from August 2010 to September 2011.

Materials and Methods: Study consisted of 100 patients and divided into two groups. Both the groups received medical therapy from day 1 which included                Metronidazole injection 500mg i/v 8 hourly. Liver abscess was diagnosed on clinical features, ultrasound finding, aspiration with clinical study and serological tests for amoebiasis In Inclusion criteria; age greater than 12 years and less than 60 years and Evidence of liver abscess on abdominal ultrasound. In Exclusion criteria ; a) Patients of less than 12 years and more than 60 years and pregnant woman.

Results: Mean age of ALA in Group A 36.98+ 3.25 years in both group with male female is ratio of 4:1. Anaemia was present in 76% cases, leukocytosis was found in 90% case. Among them 4(4.44%) cases had leukocyte count greater than 30,000/mm3 with absolute neutrophilia. 16(17.77%) patients had TLC in the range of 21 ,000-30,000/mm3. However, the majority of cases 70 (77.77%) had TLC in the range of 10,000-20,000/mm3 and only 10 patients had normal TLC. ESR was found in triple figure in 24% cases, whereas in 40% cases it was between 50 and 100 and in 36% patients found below 50mm/1st hour. Liver aspiration was done in 72 cases. The colour of aspirate was reddish brown in 60 cases (83.33%) and yellowish in 12 cases (16.66%). Air bubbles were not demonstrated in any case. Trophozoites of Entamoeba histolytica were demonstrated in 5 cases (10%). Serologic test for ALA i.e. indirect haem agglutination test was proved to be very specific with 100% showing high antiamoebic antibody titre. The mean abscess size 6.5 cm in Group A and 7.3 cm in group B. The mean abscess size and the impact of aspiration in terms of normalization in fever, TLC and improvement in LFTs.

Conclusion: Percutaneus aspiration is a safe and effective treatment of amoebic liver abscess disease.