Liver abscess: retrospective study about 36 cases Diagnosis and therapeutic approach

Abstract

Aims: As a rare condition, liver abscess has an impact on 20 out of 100000, mostly aged between 60 and 70 years old. The etiologies are dominated by biliary diseases and 20% of cases are idiopathic. Rapid diagnosis serves as prognosis factor but late diagnosis may lead to high mortality rate. The objective of this study is to report the specificities of our series and evaluate our support. Materials and methods: It is a retrospective study on 36 cases of hepatic abscess followed in our service of General Surgery of the hospital Habib Thamer 1998-2016.<strong> Results: They are 36 patients, with a sex ratio equal to 1 and an average age of 62 years with extremes of 18-84 years. The first consultation period varied from 4 days to more than 2 weeks. Observations resulted in an altered General State (33%), a triad of Fontan (22%), a triad of Charcot (17%) as main tables. The clinical examination noted a fever in 84% of cases, a right hypochondriac pain in 88% of cases, a pallor Mucocutaneous-mucosa was found in 47% cases and jaundice in 22% cases. Abscesses size varies from 2 to 14 cm with more than 68 percent varies from 5-10 cm. In 10% of cases, the size reached more than 10 cm, and in 22% of cases the abscess is less than 5 cm. 53% of the causes are gallstones with more than 14 cases of abscess are of angiocholitis origin. In 7 cases, the abscess was idiopathic. The treatment of hepatic abscesses was based on antibiotic therapy. It has been administered for a period of 1 month. Percutaneous drainage has been tried with 11 patients of abscesses sized between 5 and 10 cm. The evolution was marked by two cases of recurrences and 2 cases of failure of drainage. Surgical drainage has been tried with 23 cases among which 7 cases have been subject to coelioscopy drainage and 2 cases of recidivism were noted. The etiologic treatment was as follows: 8 cholecystectomies made including 5 by laparoscopic way. The sequential treatment was done 6 times for cases of cholangitis resulted in a case of severe pancreatitis. Moreover, a balanced medium-term recurrence left hepatectomy for Caroli disease and a duodenal foreign body extraction were completed successfully. Evolution was marked with 5 cases of sepsis, including one death, 1 case of diaphragmatic trauma and 1 case of deglobulisation as a result of drainage scanoguide Conclusion: Hepatic abscess affects the elderly of 60 years old. Antibiotic therapy and percutaneous drainage are successful first-line treatments. Surgery keeps certain indications however laparoscopy is an alternative for liver abscess treatment of biliary origin. Hepatic abscess is still a pathology that can lead to serious complications.