Hippocrates originally described liver abscesses in 400 BC, and they are still a major medical concern today. Liver abscess is typified by the existence of pus-filled liver lesions, usually caused by infectious causes, and it can have potentially fatal consequences. [1, 2] Bacterial, parasite, or fungal infections can cause liver abscesses, which are severe and possibly fatal conditions marked by a pus-filled cavity inside the liver parenchyma. Liver abscesses continue to pose a serious health risk despite improvements in diagnostic and treatment techniques, particularly in developing nations. The two main categories are amoebic liver abscess (ALA), which is brought on by Entamoeba histolytica, and pyogenic liver abscess (PLA), which is brought on by bacterial infections. Due in large part to the growing prevalence of risk factors such alcohol consumption, poor hygiene, diabetes mellitus, and immunosuppression, the incidence of liver abscess has grown recently [3, 4]. Escherichia coli, Klebsiella pneumoniae, and several Streptococcus species are the main culprits behind pyogenic liver abscesses. These abscesses frequently develop as a result of biliary or gastrointestinal infections. With a mortality incidence of 2–13%, pyogenic liver abscess (PLA) is a potentially fatal condition. It is brought on by several kinds of microorganisms invading the liver through a number of pathways, including the biliary system and bloodstream [5]. Depending on the causative organism and the patient's underlying health, PLA can present with a variety of clinical symptoms and outcomes. Because of inadequate sanitary conditions, amoebiasis is a prevalent problem in poorer nations. The most frequent extraintestinal sign of amoebiasis is an amoebic liver abscess. Amoebic liver abscess is endemic in India. It could show up as an acute abdomen that needs a laparotomy right away. Liver abscesses often result in spontaneous intraperitoneal rupture, extraperitoneal and retroperitoneal rupture, and intrathoracic rupture. A liver abscess may rupture as a result of a delayed diagnosis, raising both morbidity and mortality [6]. Clinically, liver abscesses manifest as nonspecific symptoms such as fever, abdominal pain in the right upper quadrant, nausea, and vomiting. Serious side affects such sepsis, abscess rupture, and secondary organ spread can result from these abscesses if they are left untreated [7]. Modern radiological methods like CT and ultrasound scanning have significantly improved our capacity to diagnose hepatic abscess and expanded our knowledge of its natural course. With a sensitivity of 85% to 95%, ultrasound is the recommended first diagnostic method for liver abscesses. Lesions larger than 2 cm in diameter can be detected by ultrasound. However, CT has a number of benefits over ultrasonography. It can identify abscesses as tiny as 0.5 cm and has 95% sensitivity.

Additionally, CT can identify tiny abscesses in fatty livers and close to the diaphragm. Additionally, CT aids in the detection of any related intra-abdominal pathology, such as diverticulitis, appendicitis, pancreatic masses, colonic malignancies, and intraperitoneal abscesses [8]. Two crucial therapeutic options for liver abscesses are conservative care and percutaneous aspiration. Even though diagnosis and therapy have advanced significantly, there is still a significant diagnostic and therapeutic challenge that contributes to morbidity and death. The development of imaging methods like USG, CT scans, and serology tests has made it simple, quick, and accurate to diagnose liver abscesses [9].

Aim and Objectives:

This was a prospective hospital based study carried out in the Department of Surgery, Shyam Shah Medical College and Sanjay Gandhi Hospital Rewa M.P. Duration of study was 16 months start from September 2022 to December 2023.

All Patients admitted in the surgery ward with clinical features of liver abscess both diagnosed and undiagnosed were enrolled.

For each patient, a detailed history, demographic data (age, gender), risk factors, clinical examination and laboratory profiles of the patient were recorded. Treatment modalities (conservative, percutaneous aspiration, catheter drainage or open surgical drainage) were done as per standard guidelines. All patients underwent complete blood count, renal function test, liver function test and coagulation profile. Reference ranges were defined as per the hospital protocol. 

Ultrasonography is a highly sensitive test for liver abscess and the affected lobe of the liver was identified using USG with sizes varying from 3cm to 17cm

All the necessary information regarding the study was explained to the patients or their valid guardian. Informed written consent was taken from the patients or their guardian. Detailed history was taken from the study group to establish proper diagnosis.

STATISTICAL ANALYSIS: Data were compiled using MS Excel and analysed using SPSS software (version 23). Categorical variables were presented as percentages, and continuous variables were presented as mean and standard deviation..

The liver abscess was classified according to their causative organisms as Amoebic or Pyogenic liver abscess. Out of 300 patients, 214 (71.3%) presented with Amoebic Liver Abscess and 86 (28.7%) presented with Pyogenic Liver Abscess.

Majority of the patients (83.4%) presented with abscess in the right lobe of liver, 8.3% involved left lobe of liver and 8.3% involved both lobes of liver. Most of them (78%) presented with single abscess and (22% presented with multiple abscesses cavities.

Table 1: Distribution of patients according to the variables

The most common clinical manifestation were abdominal pain (100%) followed by Fever (52%), nausea and vomiting (17.33%), jaundice (3.33%) and loss of appetite (0.66%). [Graph: 1]

Graph 1: Distribution of patients according to the Clinical manifestations

Among risk factors of liver abscesses, 49.3% had history of alcohol intake, 20% had history of diabetes mellitus and 30.7% cases have not associated any risk factors.  

Graph 2: Showing distribution of respondents based on the risk factors

Among treatment modality, pigtail catheter insertion was done in majority (49.66%) of the cases, followed by aspiration was done in 28.6% patients, 17.3% patients were managed conservatively, 2.67% patients underwent exploratory laparotomy and 1.67% underwent Intrapersitoneal drainage tube insertion.

Table 2: Distribution of patients according to the various modalities of treatment

The most common organism isolated was Klebsiella pneumoniae (41.86%) followed by Staphylococcus aureus (33.72%) in pyogenic liver abscess. The other organism isolated includes Escherichia coli (24.41%).

Graph 3: Types of organisms isolated in pyogenic liver abscess

Among laboratory parameters, (77.33%) of them had elevated TLC and (56.66%) had anemia. A total of (42.33%) of the patients had elevated alkaline phosphatase with elevated SGOT in (47.66%), SGPT in (43.66%), elevated RBS in (14.33%) and deranged INR in 13.66% patients respectively.

Table 3: Distribution of patients according to the laboratory profiles (n=300)

Liver abscess is still a serious illness and a diagnostic challenge. This is reflected in significant mortality rates and is a result of the lack of specificity of clinical signs and laboratory results. Despite the recommended aggressive approach to treatment, mortality rates throughout the mid twentieth century remained high. New advances in diagnostic and therapeutic radiology, coupled with improvements in microbiological identification and therapy, have recently decreased mortality rates

Diabetes and alcoholism were the most common risk factors of the liver abscess in the present study which was comparable to previous studies like: Mukhopadhyay M, et al [10] and Ghosh S, et al [11]. High alcohol consumption by males increases susceptibility to amoebic liver abscess. Alcohol impairs the ability of Kupffer cells to clear amoeba in the liver. Diet rich in iron content as obtained from country liquor and carbohydrate rich diet predisposes to invasive amoebiasis.  Diabetes mellitus is associated with 3.5‑fold increased risk of liver abscess due to impaired leucocyte adherence, chemotaxis, phagocytosis and antioxidant systems, resulting in reduced bactericidal activity.

In our study right lobe of liver was commonly involved and solitary abscess was most common, similar finding reported by GK Dhaked et al [12] and Aradya H.V, et al [13].

Pain in abdomen, fever, nausea and vomiting were the common symptoms reported in this study, in agreement with the N.Sharma, et al [14] and Abbas MT, et al [15].

Amoebic liver abscess was more common than pyogenic liver abscess in the present research, accordance with the Jayakar SR, et al [16]. As a tropical subcontinent, the poor living conditions and hygiene in the developing countries, more patients are affected through the feco-oral route and present with amoebic liver abscess. In temperate and developed countries, the pyogenic liver abscess is comparatively higher.

The most common organism isolated was Klebsiella pneumoniae followed by Staphylococcus aureus in pyogenic liver abscess, consistent report seen by Long, et al [17] and Wang JH, et al [18].

Patients with Small abscesses showed excellent result on i/v antibiotics therapy alone. Open surgical drainage still stands to be the gold standard treatment for complicated liver abscess, correlates with this study [19].

In the present study percutaneous pigtail catheter insertion and aspiration under Ultrasonography guidance was the most effective treatment method for liver abscesses, our results collaborative with the Maheshwari T, et al [20] and Subhash et al [21].

We have found that the common biochemical abnormalities were elevated liver enzymes (SGOT/SGPT), elevated alkaline phosphatase and hypoalbuminemia, these findings supported by Jain et al [22].

Among hematological parameters this study observed elevated TLC and anemia were common among liver abscess patients, concordance with the Lee, et al [23].

Liver abscess is a major problem in developing countries like India. Diabetes Mellitus and Alcohol use are the two important risk factors for the development of liver abscess. The most common clinical manifestations were abdominal pain and fever. Single solitary abscesses were common. Pigtail catheter insertion and aspiration were the most effective treatment modalities Future research should focus on regional variations in pathogen prevalence and the impact of socio-economic interventions on reducing liver abscess incidence

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