IntroductionLiver abscesses are rare, but whenever they occur, it is predominantly among males over 60 years of age. The paradigm in the treatment has changed, and percutaneous drainage is now the initial treatment for drainage of the abscesses. Open surgery is reserved for patients with septated abscesses and those greater than 5 cm. ObjectiveTo study the etiological, clinical, pathological, and demographic characteristics of individuals with liver abscesses and to evaluate the outcome associated with different treatment strategies. MethodsThis clinico-epidemiological study was carried out at a tertiary care hospital in Jodhpur. One hundred patients with liver abscesses were studied. Patients were assigned to three groups: Group 1 -medical management alone (in non-aspirable uncomplicated abscess), Group 2 -USG-guided needle aspiration or pigtail percutaneous catheter drainage plus medical management (in unruptured aspirable abscess), Group 3 -open surgical drainage plus medical management (In ruptured abscesses). Of the total patients, 36% were treated with medical therapy alone, 45% with USG-guided needle aspiration, 10% with USG-guided percutaneous catheter drainage, and 9% with open surgical drainage. ResultsIn our study, fever and hepatomegaly were the commonest presentations, observed in 91% and 62% of cases, respectively. Escherichia coli (E.coli) was the predominant organism cultured in 28 (43.75%) patients followed by Klebsiella growing in 24 (37.50%) patients. The right lobe was affected more (83%) than the left lobe and in the majority (83%), a solitary abscess was present. The mean age of liver abscess presentation was 40.72 years, with a 5.67:1 male-to-female ratio. Alcohol consumption was reported by 33% of patients, the majority of whom were men. Serum bilirubin was elevated in 56% of liver abscess patients, while it was normal in 44%. The mean serum bilirubin was 2.08 mg/dl. The mean value in group 1, group 2, and group 3 was 1.44 mg/dl, 2.23 mg/dl, and 2.57 mg/dl, respectively. Liver abscesses were identified in 76% of patients with right lobes; 83% had solitary liver abscesses and 17% had numerous abscesses. Abscess culture showed E. coli in 21 (32.81%) and Klebsiella in 17 (26.56%) patients. ConclusionRight-sided solitary pyogenic liver abscess caused by E.coli is the most common liver abscess, with fever and hepatomegaly as the most common presentation. Non-aspirable liver abscesses, regardless of aetiology, can be successfully treated by medical therapy alone. Needle aspiration or catheter drainage is standard for liver abscesses. Thus, needle aspiration has replaced the surgical exploration of liver abscesses.

Background: A diagnostic approach for complicated appendicitis is still controversial. We analyzed the preoperative laboratory markers that may predict complicated appendicitis.Methods: To study the role of leukocytosis, hyperbilirubinemia, decreased mean platelet volume (MPV) and increased international normalized ratio (INR) in the prediction of complicated appendicitis. Total 60 patients were enrolled and divided them into 2 groups, un-complicated (AUA) and complicated (ACA) acute appendicitis, each having 30 cases.Results: Total leucocyte count (TLC) >10000 mm³ was found in 70% of AUA cases and 80% of ACA cases serum bilirubin >1 mg/dl was found in 66.67% of AUA cases and 80 % of ACA cases. MPV<7.6 fL was found in 60% of AUA and 80% of ACA cases INR >1.2 was found in 20 % of AUA and 40% of ACA cases. TLC >10000/mm³, serum bilirubin >1 mg/dl and MPV <7.6 fL was found in 46.67% of AUA cases and 70 % of ACA cases.Conclusions: Total leucocyte count, serum bilirubin and mean platelet volume have a predictive potential for the diagnosis of complicated appendicitis.