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Amoebic liver abscess--results of a conservative management policy
P L McGarr1, T E Madiba, S R Thomson
1Department of Surgery, University of Natal and King Edward VIII Hospital, Durban.
Objective:
To evaluate the safety and efficacy of conservative management of amoebic liver abscesses.
Design:
A prospective study carried out over a 1-year period.
Setting:
Inpatients and outpatients in a tertiary referral institution.
Subjects:
Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours.
Main Outcome Measures:
Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain).
Results:
In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category.
Conclusion:
Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.