AMEBIC LIVER; ABSCESS; INCIDENCE AND OUTCOME

Amoebic liver abscess is a common infection in third world countries like ours due to poor sanitary arrangements. It presents withsevere pain and high grade fever and if not diagnosed and treated promptly, may lead to complications and mortality. Objectives: To estimatethe incidence, need for aspiration and treatment outcome. Design: Case series study. Setting: At respective consultations centers inFaisalabad. Period: From 1st, January, 2007 to 31st December 2008. Patients and Methods: All patients suspected of the diagnosis of liverabscess whether presenting to physicians or surgeon were referred for ultrasonography for the confirmation of the diagnosis. Basic biodata,coexisting medical or surgical diseases and relevant investigation were recorded, and patient was assessed for the need to aspirate theabscess. After initial treatment patients were reassessed for the need to aspirate the abscess on third, tenth and twentieth day both clinically andultrasonically. Results: We had 188 cases in the study. There were 128(68 %) males and 60 (32%) females. Majority, 156 (76.6%), of theabscesses were single, 40(21%) had double and 4 (2%) had three abscesses.166 (83%) were situated in the right lobe, 28(15%) in the left lobeand 4 (2%) had abscess in both lobes. 16 (9%) were aspirated at presentation due to their size or position. Only 4 (2%) were aspirated at firstfollow-up on third day due to non resolution of pain or fever or increase in size. All the patients who were not lost from follow up responded tostandard treatment of metronidazole. Discussion: Amoebic liver abscess is a common diagnosis in our setup. Patients presents with rightupper quadrant pain and fever. Clinical background and ultrasonogram give a reasonable suggestion about amoebic etiology. If initial aspirationis not indicated due to size larger than 5cm. or proximity to surface or nonresolution of symptoms or lesion in left lobe, conservative treatmentwith oral or intravenous metronidazole is successful.