Sistema gastrointestinal y digestivo

Abstracto

Hyperbilirubinemia in Patients with Amoebic Liver Abscess: A Study of 75 Cases

Anil Kumar Sarda, Anurag Mishra, Navdeep Malhotra and Alpana Manchanda

Background: Hyperbilirubinemia is a frequent occurrence in patients with amoebic liver abscess (ALA). Despite this, the cause of jaundice has not been established. It is presumed to be either due to parenchymal destruction or due to cholestatis due to pressure on the intrahepatic bile ducts by the abscess cavity or a combination of both. Aim: The present study is designed to study the incidence and the cause of hyperbilirubinemia in patients with ALA. Settings and design: prospective randomized controlled study Methods and material: Study was performed in a tertiary care centre with high volume of patients of liver abscesses. We evaluated 75 patients of liver abscess from December 2008 to March 2010 and based on presence or absence of hyperbilirubinemia, divided into Group I (serum bilirubin ≥ 1 mg/dl) and Group II (serum bilirubin <1 mg/dl). After detailed evaluation, both the Groups were compared on basis of parameters like clinical symptoms (e.g. fever, pain), alcohol intake, leucocytosis, bilirubin levels, liver enzymes, size of cavity, and response to treatment. Statistical analysis used: Chi square test/ Fischer’s exact test was used for qualitative data, and for quantitative data, t-test/Mann Whitney test was used. Results: In this study, we found hyperbilirubinemia in 23 of total 75 ALA patients with incidence of 30.7%. Overall the serum bilirubin values ranged from 0.4 to 11.7 mg/dl (mean=1.551) whereas in group 1 it ranged from 1.3 to 11.7 mg/dl (mean=3.71). The high values of bilirubin were associated with elevated alkaline phosphatase enzyme in 21 of 23 cases (91.3%) however significant biliary radical dilatation could not be found. The Jaundice responded well to the drainage of abscess cavity. Conclusions: Hyperbilirubinemia occurs frequently in cases of amoebic liver abscess which seems to obstructive in nature and it can be treated by surgical drainage of the abscess cavity. Further large volume and more detailed studies are needed to confirm the findings.