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Abstracts JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY

21st Annual Conference of Indian National Associationfor the Study of Liver (INASL), March 22–24, 2013

Hyderabad International Convention Centre, Hyderabad, India

MISCELLANEOUS

SUCCESSFUL ENDOSCOPIC S REMOVAL OFLARGE TRICHOBEZOAR

Parveen Malhotra,12 Vani Malhotra,1 Ramesh Verma,2

Yogesh Abhishekh12

1Department of Gastroenterology, OBG, PGIMS Rohtak, Vellore, India,2Department of Gastroenterology, Christian Medical College, Vellore,India

Background: Trichobezoar is a ball of swallowed hairwhich collects in the stomach and fails to pass throughthe intestines. The risk is greatest amongmentally retardedor emotionally disturbed children.Case: a 16-year-oldmentally subnormal girl presented withsecondary amenorrhoea for last two years. She was also giv-ing history of lump and pain in the abdomen. Abdominalexamination revealed a firm, non-tender mobile massoccupying the epigastrium and extending to right hypo-chondrium and lumbar region. Endoscopy confirmed a tri-chobezoar in the stomach.Result: the trichobezoar was removed in multiple sittingsusing an endoscope.Conclusion: This is one of rare case report all over worldwhere such a big trichobezoar was removed successfully en-doscopically without subjecting patient to surgery.Coun-seling by a psychiatrist has an important role inprevention of the recurrence. Trichobezoar should be con-sidered a differential diagnosis in any young girl who pres-ents with epigastric pain, vomiting and abdominal mass.

Corresponding author: Parveen Malhotra.E-mail: drparveenmalhotra@yahoo.com

PERCUTANEOUS INTERMITTENT NEEDLEASPIRATION VS PERCUTANEOUS CATHETERDRAINAGE OF LIVER

Ashok Jhajharia, Amit Soni, Sandeep Nijhawan,Subhash Nepalia, Amit Mathur

S M S Medical College Jaipur, India

Background and Aims: Liver abscess is a common prob-lem. Treatment ranges from only antibiotic to antibioticwith percutaneous intermittent needle aspiration and anti-

© 2013, INASL Journal of Clinical and

biotic with percutaneous catheter drainage. No random-ized trial has been done to directly compare both invasivetechniques till now. Our study has compared intermittentneedle aspiration with catheter drainage.Method: Over a 12 months period, 140 consecutivepatients with liver abscess were treated with intravenousantibiotics initially and those who did not respond or de-veloped complications were randomized into two, percu-taneous treatment groups: continuous catheter drainage(with an 8F multi-sidehole pigtail catheter); and intermit-tent needle aspiration (16G, 18G disposable trocar nee-dle).Results: Baseline characteristics and demographic profileof both groups of patients was similar. The needle groupwas associated with a higher treatment success rate,a shorter duration of hospital stay, and a lower mortalityrate, although this did not reach statistical significance.In pigtail catheter group there were 12 (37%) procedure re-lated complications whereas in percutaneous aspirationgroup there were, 8 (12%) complications. The differencewas statically significant (P >.05)Conclusion: The symptomatic large (>6cm) size liver ab-scesses not responding to iv antibiotic therapy alone haveeasier, safer, less costly, and less time consuming treatmentwith antibiotics and intermittent aspiration than continu-ous catheter drainage.

Corresponding author: Ashok Jhajharia.E-mail: drashokjhajharia@gmail.com

SEVERE HEPATIC INSUFFICIAENCY, ASA MANIFESTATION OF SYSTEMICASPERGILLOSIS

Maria Chichkina, Gennadiy Storozhakov, Llia Fedorov,Svetlana Kosyura, Gennadiy Petrenko, Llia Karabinenko,Svetlana Morozov, Gennadiy Llchenko

Clinical Hospital N� 12, Moscow, Russian Federation, Russia

Background and Aim: Acute aflatoxicosis rarely diag-nosed in humans. However, one should consider the possi-bility of its development in a patient with jaundice. Presenta case of systemic aspergillosis, flowing under the "guise"of decompensated liver cirrhosis (LC) with the develop-ment of sepsis.

Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S118–S124

JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY

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Case: Patient M., 47 years old, disease duration 6 months,acute onset of the disease - with jaundice, dyspepsia, severeweakness, hectic fever. During hospitalization - coma I, in-tense jaundice, dyspnea, anasarca. In the lungs, breathingweakened, tachycardia, hypotension. Percussion is notenlarged liver and spleen were not palpable. In the analysisof anemia (red blood cells - 2.62 x 106 / m), leukopenia(1.2 x 103 / m), granulocytes (91%), thrombocytopenia(19 x 103 /m); hyperenzymemia (2.5 standards), hyperbilir-ubinemia and 26 standards (direct bilirubin> 10 stan-dards), total protein - 41 g / l, albumin - 23.3 g / l,prothrombin - 26.3%, INR - 2.43. By CT scan - polysegmen-tal bilateral pneumonia, hydrothorax, portal hypertension,ascites. Blood culture was negative. Bronchoscopy: on theback wall of the trachea revealed ulcerative defect of 2 cminstalled sepsis without identifying the primary tumor tothe development of severe organ failure, secondary hepat-opathy ended in death. Autopsy - signs of septicemia,with damage to internal organs (brain, heart, kidneys,lungs) - necrosis of the vascular wall and bleeding intothe surrounding tissue. Electron microscopy autopsiro-vannoy liver tissue were found in the fields of the myceliumof the fungus germinal form, as well as the typical structureof hyphae Aspergillum fumigatus (A.f.). In crops bronchialwashings obtained after the death of the patient, in a lot of(A.f.).Conclusion: The patients in the presence of clinical de-compensation cryptogenic LC in differential-diagnostic al-gorithm is appropriate to include systemic mycoses.

Corresponding author: Maria Chichkina.E-mail: Mariachichkina@gmail.com

PROGNOSTIC VALUE OF HEPATICDYSFUNCTION IN DENGUE INFECTION

Ravi Shankar Bagepally, G. R. Srinivas Rao,B. Surendar Reddy, B. Vijay Kumar,B. Vamshi Krishna Reddy, S. Jithender Reddy,Sikanta Kumar Raut, T. J. Sri Gowri, S. Kethan Reddy

Yashoda Hospitals, Secunderabad, Andhra Pradesh, India

Background: Dengue is a mosquito borne arboviral infec-tion endemic to most tropical and subtropical countries.Hepatic dysfunction is common in dengue infection andis attributed to direct viral effect on liver cells or as a conse-quence of dysregulated host immune responses against thevirus.Objectives: To assess the prognostic value of transami-nases and other factors on the outcome of patients withdengue infection.Methods: We performed a retrospective analysis of 105hospitalized patients with serologically confirmed denguefever. Clinical features, presentation of liver disease and

Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No

liver function tests were analyzed in all patients. Dengueinfection was confirmed by ELISA tests. Hepatitis B andC infections were excluded by ELISA in all patients. In pa-tients with transaminases more than 300 IU/ml, hepatitisA and E were excluded by serological assay. The study pe-riod was for 12 months from Jan to December 2012.Results: Out of 105 patients, males were 74 (70%).Thenumber of subjects survived was 93 (89%) and the rest 12(11%) succumbed to the illness. Aminotransferases were el-evated in majority of patients. The main differences be-tween survived (n=93) and mortality (n=12) group is asfollows. Mean value of Platelets was 0.95 L/mm3 (survived)and 0.65 L/mm3 (mortality group), mean value of Bilirubinwas 1.03 mg% (survived) and 3.6 mg% (mortality group),mean value of SGPT was 260 IU/mL (survived) and 931IU/mL (mortality group), and mean value of SGOT was390 IU/mL (survived) and 1075 IU/mL (mortality group).Ascites was noted in 24% survived group and 25% in mor-tality group. Bleeding was seen 8%in survived group and17% inmortality group. Encephalopathy was absent in sur-vived group and 8% inmortality group. Respiratory Failurewas 10 % in survived group and 33 % in mortality group.Bradycardia was 12% in survived group and 75 % inmortal-ity group.Conclusion: In patients with dengue fever, elevated biliru-bin level and transaminase values beyond 1000 IU/mL sug-gests poor outcome. Additional features like bradycardia,bleeding, respiratory failure and encephalopathy havebad prognostic implication.

Corresponding author: Ravi Shankar Bagepally.E-mail: b_ravishankar@yahoo.com

SPECTRUM OF LIVER DISEASE INPREGNANCY AND THEIR EFFECT ONMATERNAL AND FETAL OUTCOME

Mohan B. Goyal, Mandhir Kumar, Naresh Bansal,Piyush Ranjan, Ashish Kumar, Munish Sachdeva,Rinkesh Kumar Bansal, Anil Arora

Department of Gastroenterology and Hepatology, Sir Ganga RamHospital, New Delhi, India

Background and Aims: Deranged liver function test(LFT) during pregnancy is common problem. There is noIndian study which studies the entire spectrum of liver dis-ease in pregnancy. Aim of this study was to assess spectrumof liver disease in pregnancy and determine its effect onmaternal and fetal outcome.Methods: All patients with abnormal LFT referred byobstetric unit of our hospital between July 2011 andDecember 2012 were included. LFT, viral markers (HBsAg,anti-HCV IgM, anti-HEV and anti-HAV IgM), USG upperabdomen, and autoimmune markers were done in all

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