LIVER, Abscess of.
Multiple or pymic hepatic abscesses are always fatal.
Tropical or simple abscess of the liver is seen in this country amongst returned Anglo-Indians, and is regarded as a sequela of dysentery, though Sir Havelock Charles has proved that the suppuration is very often independent of dysenteric infection.
Preventive treatment in Europeans suffering from amoebic dysentery consists in absolute rest in bed, a mild liquid diet and the use of Ipecac. or Emetine in large doses to combat the organisms to whose presence the dysenteric symptoms are due. An important factor in all treatment is the cleansing of the alimentary canal by Saline Purgatives. Rogers maintains that the hepatitis in its presuppurative stage may be effectively dealt with by large doses of Ipecac. or Emetine, which prevents abscess formation as soon as marked leucocytosis with little or no polynuclear increase has demonstrated its presence. Some attach value to Ammonium Chloride.
Aspiration succeeds in a small percentage of cases when pus has formed. Manson's method consists in tapping with a full-sized trochar and canula and introducing through the canula a long rubber tube through which the pus is siphoned off after the withdrawal of the canula.
The danger of pus welling along the track of the aspirator needle and infecting the peritoneum is always a real one, hence most surgeons in superficial or deep abscesses recommend a free abdominal incision under strict antiseptic precautions; after the abdominal cavity has been carefully cut off by sterile gauze packing a large trochar is plunged into the abscess and the track of the puncture seared by the Paquelin cautery and the sac washed out through a rubber tube with warm Saline or weak Quinine Solu tion, the tube being kept in position for drainage by gauze packing. Or
the liver may be sutured to the edges of the wound made in the parietal peritoneum. Statistics afford evidence of the frequent subsequent septic infection of the abscess cavity, and the most stringent antiseptic precau tions are necessary. Free incision and drainage are the best means of obviating these dangers.
Rogers after aspiration injects Emetine into the sac in all amoebic cases and gives the drug hypodermically as well. Where the abscess cannot be reached through the abdominal route the pleura must be opened, and it may be necessary to resect a portion of one or more ribs as in the opera tion for suppurating hydatids.