Management of Ruptured Liver Abscess: A Study of 54 Cases

Liver abscess is a common condition in the tropical countries and associated with significant morbidity and mortality. Two major classifications are pyogenic abscess and amoebic abscess. Rupture of the liver abscess is common and fatal and a cause of fraction of the deaths in tropical countries like India and is an important part of the differential diagnosis of patients with acute abdomen in this region. Improved imaging techniques have aided in the diagnosis of hepatic abscess and have role in treatment also. As previously open surgery was the only choice, with invent of effective antimicrobials, USG, CECT, laparoscopy, mortality associated with the condition has significantly decreased. With this study various pathological and epidemiological factors in patients with rupture liver abscess are analysed for better management and insight into the prognosis for such patients. USG is the investigation of choice as diagnostic as well as therapeutic purpose. Percutaneous needle aspiration is effective in majority. Insertion of pigtail catheter is effective in selected cases. Emergency open surgery is usually the treatment of choice in critically ill patients and with associated intra-abdominal rupture. Laparoscopic drainage is highly effective in management of large and freely ruptured abscess with decreased mortality, post-operative recovery and complications.