A Comprehensive Study on Ruptured Liver Abscess in a Tertiary Care Center.

Autor:	Singh A; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Paruthy SB; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Kuraria V; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Dhawaria M; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Khera D; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., M S H; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Raju H; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Madhuri SS; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Saini Y; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND., Kumar A; General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 14; Vol. 16 (7), pp. e64526. Date of Electronic Publication: 2024 Jul 14 (Print Publication: 2024).
DOI:	10.7759/cureus.64526
Abstrakt:	Background Bacteria and parasites cause liver abscesses (LAs), with the unusual but fatal consequence of ruptured LA. Along with the clinical signs of icterus, right upper quadrant pain, and a history of loose stools, patients present with non-specific symptoms such as fever, nausea, and generalized weakness. Consistent findings include male sex prevalence and frequent alcohol consumption. Leukocytosis, abnormal liver function, and an increased international normalized ratio have been identified by biochemical analysis; however, these findings are not specific to a ruptured LA diagnosis, and imaging is necessary to reach a definitive diagnosis. Ultrasonography usually confirms the diagnosis, and computed tomography is required in certain situations. In confined ruptures, percutaneous drainage combined with antibiotic therapy is typically the initial treatment course. Generally reserved for non-responders or moribund patients with delayed presentation, an open surgical approach may involve simple draining of a ruptured abscess or ileocecal resection, or right hemicolectomy in cases of large bowel perforations, both of which increase patient morbidity. A definite guide to management is still missing in the literature. In this article, we have discussed and correlated with data the predictors of surgery and preoperative predictors of perforation. Materials and methods This retrospective study was performed at Safdarjung Hospital, New Delhi, between January 2022 and December 2023. The study included 115 patients diagnosed with ruptured LA by ultrasound. Medical records were analyzed, and various parameters of the illness, clinical features, hematological and biochemical profiles, ultrasound features, and therapeutic measures were noted and assessed. Results Of the 115 patients, 88% (n = 101) were male. The most common symptoms were abdominal pain (114 patients) and right upper abdominal tenderness (107 patients). Fifty-two patients were treated with percutaneous drainage, and 42 underwent laparotomy. Intercostal drainage (ICD) tubes were placed in 19 patients. Sixteen patients had large bowel perforations. Twenty-three patients died (20%), including 17 patients who underwent laparotomy and nine patients who had large bowel perforation (39.1% associated with overall mortality, 52.9% associated with mortality in laparotomy). One patient with percutaneous drainage and a right ICD tube died in the intensive care unit. Four patients died before intervention. Significant associations were noted between perforation and mortality in patients who underwent surgical drainage. Loose motions, alcohol and smoking consumption, and deranged creatinine and albumin levels were found to have a significant association with surgical drainage. Conclusion The study found that a ruptured liver abscess (LA) may require surgery to drain the collection or repair the pathological bowel, which increases the morbidity, but it is a lifesaving procedure over percutaneous catheter drainage. The study also identified factors associated with a higher risk of death, such as a history of loose stools and low blood albumin levels. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Vardhman Mahavir Medical College and Safdarjung Hospital issued approval IEC/VMMC/SJH/Project/2024-02/30. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Singh et al.)
Databáze:	MEDLINE
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