A 30 years old man presents with history of abdominal pain since 15 days. He has history of intermittent mild fever, loss of appetite and had episode of diarrhea a month back. On examination he has tenderness in right hypochondrium. Ultrasound and CT scan study of abdomen showed a 5cm X 5cm X 6cm sized hypoechoic and hypodense focal lesion respectively about 1 cm deep to the liver capsule in the right lobe. Which of the following would be most correct regarding Rx of this patient?
|A||Metronidazole therapy should be the Rx.|
|B||Percutaneous aspiration and Metronidazole should the Rx.|
|C||Surgical drainage of abscess with Metronidazole would be the best Rx.|
|D||Resection of involved segment of the liver|
(Ref: Sabiston 18th / chapter no 45)
Sabiston 18th / chapter no 45:
a. The mainstay of treatment for amebic abscesses is metronidazole (750 mg orally three times per day for 10 days), which is curative in more than 90% of patients.
b. Clinical improvement is usually seen within 3 days. If response to metronidazole is poor or the drug is not tolerated, other agents can be used.
c. Emetine hydrochloride is effective against invasive amebiasis (particularly in the liver) but requires intramuscular injections and has serious cardiac side effects.
d. A more attractive option is chloroquine, but this is a less effective agent. After treatment of the liver abscess, it is recommended that luminal agents such as iodoquinol, paromomycin, and diloxanide furoate are administered to treat the carrier state.
Therapeutic needle aspiration of amebic abscesses has been proposed.
Aspiration is recommended for:
a. diagnostic uncertainty,
b. failure to respond to metronidazole therapy in 3 to 5 days,
c. Abscesses felt to be at high risk for rupture.
(Abscesses larger than 5 cm in diameter and in the left liver lobe are thought to be a higher risk for rupture)
a. Metronidazole is the drug of choice for amebic liver abscess.
b. More than 90% of patients respond dramatically to metronidazole therapy with decreases in both pain and fever within 72 h.
Indications for aspiration of liver abscesses are:
a. The need to rule out a pyogenic abscess, particularly in patients with multiple lesions;
b. The lack of a clinical response in 3–5 days;
c. The threat of imminent rupture; and
d. The need to prevent rupture of left-lobe abscesses into the pericardium.
There is no evidence that aspiration, even of large abscesses (up to 10 cm), accelerates healing. Percutaneous drainage may be successful even if the liver abscess has already ruptured. Surgery should be reserved for instances of bowel perforation and rupture into the pericardium.