A 21-year-old boy was rushed to a hospital in Mumbai with a history of pain in the abdomen and fever for over 10 days. Blood test reports revealed that he had abnormal liver along with HIV-positive status. Further testing and CT scan showed a large liver abscess or collection of pus in the liver.
Doctors at Wockhardt Hospitals, Mumbai Central said that the pus collection was due to a fungal infection. They conducted endoscopic drainage was conducted to remove the pus. As they have claimed, this was the first case of a fungal liver abscess drained in HIV-positive patients using endoscopic ultrasound in Maharashtra and Central India.
Liver abscess can be fatal
The boy, named Harshal Patil, was admitted to the hospital in the first week of July 2022.
According to Dr. Shankar Zanwar, Consultant Gastroenterologist, the position and size of the abscess (7cm) were so huge that if it had not been treated early, it could have led to a rupture in the abdomen and resulted in a life-threatening situation.
After analyzing the various possible ways to treat the patient and related complications, Dr. Zanwar and his team decided to conduct endoscopic drainage.
He said, “Our initial plan was to drain the abscess in the liver by putting a needle and a drainage tube through the skin known as percutaneous drainage as this was a convenient way to operate on the patient. After reassessing the tract to drain this it was found that an unusually long puncture would have to be done, which was technically challenging, and the patient would have had a lot of discomfort post-procedure as it would lead to the inability to sleep or lie down on the right side since the tube would be hanging out for longer time. Thus, endoscopic drainage was explained to the patient and on his agreement, the team of doctors planned the procedure.”
How liver abscess endoscopic drainage is performed
Using an endoscopic ultra-sound method, the doctors accessed the pus collection through the stomach.
Within three days of treatment, the fever and pain subsided and the patient became completely symptom-free. He was discharged five days after the procedure and was on antibiotics for 21 days. Repeat sonography scan at 1 month showed near complete resolution of the pus collection, Dr. Zanwar stated.
According to the doctors, draining of liver abscess through endoscopic ultrasound is an unusual procedure and is performed by very few centers in India. They say simple aspiration of pus leaves a scope of incomplete clearance and prolonged time of recovery, while drainage of pus collection with drains helps early recovery.
Treatment of various abdominal diseases such as large pus collection around the pancreas blocked bile ducts or pancreatic duct narrowing have now become easier and require no major surgery.
Sonography vs endoscopic drainage
A liver abscess (pus-filled cavity) need removal, usually it is done using direct sonography and can be painful for some patient as a tube is hanging out from the abdominal wall for a few days.
Endoscopic drainage can be done for difficult to access pus collection through the abdominal wall which cannot be done using routine sonography. This avoids major surgery and offers very early patient recovery.
Dr. Shankar Zanwar
Consultant – Gastroenterologist
Wockhardt Hospitals, Mumbai Central
To book an appointment call: +918291101001
