International Surgery Journal | June 2023 | Vol 10 | Issue 6 Page 1024 International Surgery Journal Ray MS et al. Int Surg J. 2023 Jun;10(6):1024-1030 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Management of giant amoebic liver abscess with severe sepsis by open drainage: a study of 28 cases in 20 years M. S. Ray, Vishal Patel, Aditya Raval, Digpal Thakore*, Naresh Modi, Amandeep Singh, Milan Patel, Shyam Goyal, Rudrax Bhatt, Abhishek Yadav, Brinda Panchal INTRODUCTION Behind every surgical scar there is an untold story of survival! Liver abscess is a common clinical problem in tropical countries and is most commonly caused by amoebic, pyogenic or mixed infections. 1 Less commonly, the infection causing a liver abscess may be fungal in origin. For amoebic liver abscesses (ALA), the primary treatment is medical; however, 15% of amoebic abscesses may be refractory to medical therapy and 20% of ALA may be complicated by secondary bacterial infection. 2,3 In the past, surgical drainage was the traditional mode of treatment in all ALA patients and in patients with pyogenic liver abscesses (PLAs). 4 However, this type of drainage was associated with remarkably high morbidity (47%) and mortality (10%) rates. 5 Over the last three decades, out comes in patients presenting with liver abscesses have improved as a result of advances in radiological diagnosis and percutaneous treatment options. 6–8 Currently, patients are treated with antibiotics along with percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD), and surgical drainage is used only in patients who fail to respond to such treatment. 9,10 Previous studies have shown both ABSTRACT Background: Presently large amoebic liver abscesses are treated by intravenous antibiotics coupled with less invasive procedure like pigtail drainage. Pigtail drainage may not be adequate enough to drain thick pus and solid necrotic component in good number of large amoebic liver abscesses. In these cases, with severe sepsis, open surgical drainage (OSD) is a life saver and a game changer. Aim of this study was to determine whether in critically ill patient with large amoebic liver abscesses with sepsis, results in good clinical outcome, when managed by OSD. Methods: Over a 20-year period, 28 patients with giant amoebic liver abscesses, in severe sepsis, were managed by, an up-front OSD. In this prospective study we tried to evaluate the time to reversal of the toxic features of sepsis, recovery of hemodynamic stability, degree of morbidity and hospital stay. Results: In all 28 patients treated by OSD, there was certainly rapid reversal of toxic features of sepsis, decrease in leukocyte count and accelerated recovery of hemodynamic stability in all are cases Three patients had surgical site infection, which were managed accordingly. The average hospital stay was 12 days. No mortality occurred in our study. Conclusions: The results of our study show that for large amoebic liver abscesses with severe sepsis, OSD provides better clinical outcomes in terms of treatment success, rapid recovery, of hemodynamic stability, less morbidity and no mortality. Keywords: Amoebic, Liver abscess, Open surgical drainage, Percutaneous needle aspiration, Pyogenic Department of Surgery, SGT Medical College, Budhera, Haryana, India Received: 04 March 2023 Revised: 09 May 2023 Accepted: 11 May 2023 *Correspondence: Dr. Digpal Thakore, E-mail: digpalthakore10@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20231729