Journal of Surgery

Biological data	Effective	Proportion (%)
Gwhite lobules upon admission	Maverage: 33431.6±151732.9 [1200-91000]
Hyperleucytosis	21	58.3
Leucopenia	12	33.3
normal	3	8.3
Gwhite lobules at 72H	Average: 9179.7±3786.5 [4000-21000]
Hyperleucytosis	18	50
Leucopenia	15	41.7
normal	3	8.3
CRPupon admission	Average: 97.73±82.4
Raised	19	52.8
Normal	3	8.3
CRP at 72H	Average: 79.11±75
Raised	16	44.4
Normal	2	5.6
Hemoglobin levels
Normal	35	97.2
Anemia	1	2.8
ASAT
Raised	15	41.7
Normal	10	27.8
ALAT
Normal	12	33.3
Raised	11	30.6

Table 1: Distribution of Patients According to Biological Data

The abdominal ultrasound was performed at 61.1% (n: 22) of patients, showing unisegmental involvement in 33.3% (n: 12) cases and an average volume of 268.5 ml. The abdominal CT scan was performed in 58.3% (n:21), showing unisegmental or bisegmental involvement inequal proportions of 22.2% (n:8) and an average size of 10 cm (Table 2). Individually considered, segment VII was the most affected that is 19.4%, at CT scan (Figure 2). The abscess was located solely in the right lobe of the liver 44.4% (n:16) (Table 3). Amoebic serology was positive in one patient, while routine cytobacteriological examination isolated pathogens in only three patients (E. coli, S. epidermidis, K. pneumoniae). Antibiotic therapy was administered to all patients, combining metronidazole to ceftriaxone in 63.9% (n:32) or to amoxicillin clavulanic acid in 36.1% (n: 13). The antibiogram showed sensitivity to these molecules in all three cases. Drainage was ultrasound-guided in 69.4% (25) and surgery was performed in a total of 30.5% (n :11) cases (Table 4). The mean volume of pus drained was 704.4 ml [60-3200 ml], and the mean drainage duration was 4.8 days [2-14 days]. A follow-up ultrasound was routinely performed before drain removal. The mean length of hospital stay was 7.8 days [3-17 days]. After one-month and three-month follow-up, the clinical, biological, and ultrasound outcomes were favorable in 80.6% of patients (n = 29), and abscess persistence was observed in the two HIV-positive patients (Table 5).

Morphological data		Effective	Proportion (%)
Abdominal ultrasound		22	61.1
Number of segments reached	1	12	33.3
	2	7	19.4
	3	3	8.3
Volume (ml)	> 50	18	50
	< 50	3	8.3
	Average: 268.5± 220.9 [29-1011]
Abdominal CT scan		21	58.3
Number of segments reached	1	8	22.2
	2	8	22.2
	3	4	11.1
Size (cm)	> 10	3	8.3
	05-Oct	2	5.6
	< 5	1	2.8
	Average 10± 5[4-19]

Table 2: Distribution of Patients According to Morphological Data

Figure 2: Distribution of Patients According to Segmental Involvement on Abdominal CT Scan

Diagnostic/Topographic	Effective	Proportion (%)
Right liver	16	44.4
Left liver	7	19.4
Right liver + Left liver	6	16.7
PAG/rupture	4	11.1
Pre-suppurative	2	5.6
No	1	2.8
Total	36	100

Table 3: Distribution of Patients According to Thetopographic Diagnosis

Indication	Effective		Proportion (%)
Ultrasound-guided dr	ainage	25	69.4
Surgery/drainage f	ailure	7	19.4
Ultrasound-guided p	uncture	4	11.1
primary surgery		4	11.1
Scan-guided drain	age	1	2.8
Associated gestures	Toilet + drainage	3	8.3
	Ileostomy	1	2.8

Table 4: Distribution of Patients According to the indications

Table 5: Distribution of Patients According to their Progress

Discussion

The limited identification of the underlying cause, due to the sterility of the samplesand the retrospective nature of a good phase of our study were our main limitations. Liver abscess is a wellknown tropical disease. In our study, we collected 36 cases over 18 months. The study by Diarra A et al. [5], reported 9 cases per year. This demonstrates a high frequency in our study, given the tropical geographical location of our region. Young adults were the most affected in our study. An average age of 39 to 47 years has been reported in African series.[3,5]; while Lafont, in his study in France, reported an average of 60 years [4]. This difference lies in the youthfulness of the African population. The male predominance was evident in our series. This result is consistent with the findings of many authors [4-6]. According to other authors, women are less affected due to the protective action of female sex hormones and the immune response [7]. Chronic alcohol consumption was reported by some of our patients. In the series by Bignoumba I et al.[3], the finding was 62.5%. Alcohol inhibits Kupffer cells, which are essential for eliminating infectious agents in the liver [8]. Fontan’s triad was dominant in our patients. In the series by Diarra A et al.[5], 95.1% of patients presented with fever and 93.2% with abdominal pain. This classic clinical presentation is the typical form of liver abscess reported in the literature [2,3]. The average size of the abscess was 10 cm in our patients. Bignoumba I et al.[3], they reported a size between 5 cm and 10 cm in 68.8% of cases. This result could be linked to the late consultation of our patients, due to their precarious social status in rural areas on the one hand, and their initial recourse to traditional treatment on the other. In our study, the right lobe was preferentially affected. This result does not differ from those reported in the literature [3,5,6]. This location could be explained by anatomy; the right lobe represents a larger tissue mass, and portal venous flow is greater on the right than on the left. Involvement of a single segment was more frequent in our study. In the work of Bignoumba in Gabon and Diarra in Mali, the abscess was solitary in 87.5% and 70.9% of cases, respectively [3,5].

Amoebic abscess is the most frequently reported etiology in African literature [3,6,9]. In our series, bacteriology failed to isolate any germs in almost all patients, and amoebic serology was positive in one patient. This sterility of the sample could be linked to the overuse of antibiotics for fever and to the adhesion of the amoeba to liver tissue, potentially causing false negatives. Systematic dual antibiotic therapy, including metronidazole, was the cornerstone of treatment for our patients. This therapeutic approach likely reflects the microbiological context in our country and is supported by numerous case series [3,5]. In our study, ultrasound-guided drainage was performed in more than half of the patients. In the series by Dieng M et al. [6], drainage was carried out in 82.5% of cases and in 66% of cases in Diarra’s series [5]. Surgery, in the presence of peritonitis or after drainage failure, was the second indication in our study. Bignoumba et al. [3], they reported two cases requiring additional surgical drainage. Peritonitis and deep abscesses are contraindications to, or factors that can lead to drainage failure [1,6].

In liver abscesses, clinical healing is early, while anatomical lesions may persist for several months [10]. The evolution of the patients in our study was almost entirely favorable, but we noted the persistence of the abscess in the two HIV+ patients after one month of follow-up, and we had recorded no [other cases]. In the African literature, Diarra et al. [5], reported 2 cases of death and Bignoumba et al.[3]. They recorded one death, highlighting the sometimes fatal nature of this disease [2].

Conclusion

Liver abscess remains a common condition in our practice. It generally affected adults. Fontan’s triad was frequently observed. Dual antibiotic therapy, including metronidazole, combined with instrumental intervention, was the cornerstone of treatment.

Conflicts of interest: No conflict of interest for this work

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