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
