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Bailey & Love's Surgery, 27th Edition Surgery Essence by Pritesh Singh (PGMEE) Sabiston's Textbook of Surgery
Farquharson's Textbook of Operative General Surgery, 10th Edition Surgery Sixer for NBE by Rajamahendran Surgery PreTest Self-Assessment and Review, Thirteenth Edition
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Multiple Liver Abscesses

-A 50 year old male was admitted with complaints of  intermittent fevers, cough, anorexia and general malaise since 8 weeks. The patient was a known Chronic alcoholic and a chain smoker. There were no positive findings on fever workup and general investigations except that hemoglobin was 9.1 g/dl  and ESR was elevated. USG Abdomen revealed a large liver abscess. Empirical antibiotics were started.

-CECT Abdomen showed an enlarged liver with 10x9 abscess in the right lobe superior segment along with two small abscesses noted in segment VI, each measuring 3x3cm. Intrahepatic billiary radicles, portal vein, porta hepatis appeared normal. There was no evidence of periportal lymphadenopathy

Liver Abscess

Multiple Liver Abscesses

-BT/CT and PT/INR were within normal limits. USG guided pigtail catheter placement and drainage was done.

Discussion

Duration of antibiotic therapy?

-Currently 4-6 weeks of therapy is recommended for solitary lesions that have been adequately drained.
-Multiple abscesses are more problematic and can require up to 12 weeks of therapy. Both the clinical and radiographic progress of the patient should guide the length of therapy.

Intervention Plan?

-Although the primary mode of treatment of amoebic liver abscesses is medical, 15% of amoebic abscesses may be refractory to medical therapy. 
-Also, secondary bacterial infection may complicate up to 20% of amoebic liver abscesses and hence drainage may be required in many patients with amoebic liver abscesses. 
-Percutaneous drainage is now considered the treatment of choice for most intra-abdominal abscesses and fluid collections.





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