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Percutaneous drainage may not be necessary in a significant subset of patients with complicated liver abscess
Bishnu Saptarshi1, Partha Sarathi Patra2, Surender Sultania2, Avik Sarkar3, Jaba Ranjan Hembram3, Gopal Krishna Dhali2
Departments of 1Hepatology, 2Gastroenterology and 3GI Radiology, School of Digestive & Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata.

Corresponding Author
Partha Sarathi Patra


Background: Clinical features and outcomes of liver abscess are ever changing, even in South Asia, where parasitic infections are common. It is important to devise management strategies to suit the changing needs. We wanted to capture this emerging spectrum in “real life” through assessment of clinical features, management strategies and outcomes of a cohort of treated liver abscess patients at a single center. 
Methods: A retrospective study of patients admitted to a referral institution between February 2010 and June 2014 was undertaken. Patients with liver abscess who have received prior treatment in another hospital, and have then been referred for a complicated disease course were studied; their demographics, clinical presentations, evolution and outcomes were analyzed. 
Results: A total of 154 patients [males 109, 70.78%), mean age 43.71 ±16.49 years] were included in this study. Alcohol use was the most common (23.38%) predisposing factor, followed by biliary obstruction (20.78%)and diabetes (11.04%). Most common presenting features were fever, pain abdomen and jaundice [92.9%, 86.4% and 20.8% patients respectively]. Majority of patients (58.4%) had a solitary liver abscess; right lobe being the commonest site(61%). Median abscess volume was 180 ml (Range 7-1524 mL); abscess rupture occurred in 21 (13.6%) cases, most commonlyin subdiaphragmatic location. Overall, abscess drainage was required in 97 (63%) patients [single time aspiration 15 (15.5%), percutaneous indwelling catheter 80 (82.8%), surgical drainage 2 (2.1%)]. Patients who required percutaneous drainage were mostly males, had higher abscess volumes and were more frequently alcohol users and diabetics. Six (3.9%) patients died in the study period. 
Conclusion: While large abscess, alcoholism and diabetes were associated with increased need for catheter drainage, 37% can be treated by drug therapy alone. Careful selection of subjects for drainage may help in decreasing the mortality rate in this benign condition.