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CC BY 4.0 · Surg J (N Y) 2021; 07(04): e351-e356
DOI: 10.1055/s-0041-1740625
Original Article

Enhanced Drainage Protocol in Large Amoebic Liver Abscess

Jignesh A. Gandhi 
1   Department of Surgery, Global Hospital Mumbai, Parel, Mumbai, India
,
Pravin H. Shinde 
2   Department of General Surgery, Seth G.S. Medical College & KEM Hospital, Mumbai, India
,
Sadashiv N. Chaudhari
2   Department of General Surgery, Seth G.S. Medical College & KEM Hospital, Mumbai, India
,
Amay M. Banker 
2   Department of General Surgery, Seth G.S. Medical College & KEM Hospital, Mumbai, India
› Author Affiliations Funding None.
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Abstract

Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter.

Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures.

Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p-value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p-value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p-value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography.

Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

Keywords

amoebic liver abscess - drain - pigtail - biliary communication

Declarations

The study was approved by the Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.


Ethics Approval

This research study was conducted retrospectively from data obtained for clinical purposes. Ethical approval was granted by the Institutional Ethics Committee.


Availability of Data And Material

All patient records were obtained from the medical records department of our hospital.


Code Availability

Not applicable.


Author Contributions

All authors contributed to the study equally. J.A.G. developed the concept of study, designed the study, and wrote the manuscript. P.H.S. designed the study and wrote the manuscript. S.N.C. contributed toward the study design and critical review. A.M.B. did the data collection, statistical analysis, and writing of manuscript. All authors read and approved the final manuscript.




Publication History

Received: 15 January 2021

Accepted: 26 October 2021

Article published online:
23 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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