Hepatic abscess is the consequence of a localized infection of the hepatic parenchyma, leading to the formation of an inflammatory infiltrate, necrosis and possibly a collection of pus [1] . Liver abscesses are rare conditions that can be serious. This rarity is reported by several studies in Africa, with an annual variability of 1.3 cases to more than 5 cases [2] - [5] . Their prevalence and incidence have increased in recent years due to the increase in life expectancy of populations, progress in pancreatic and hepatobiliary surgery in cancerology and transplantation, the development of interventional radiology and the increase in immunodepression factors such as human immunodeficiency virus (HIV) infection, diabetes and chronic alcoholism [6] [7] .

These are infections that can be caused by bacteria and/or parasites, or more rarely fungi. Amoebic origin is more common in Africa and South-West Asia [7] - [9] , while pyogenic abscesses are more common in developed countries [6] [10] . The clinical and biological signs are often non-specific, requiring for their diagnosis to gather clinical (painful hepatomegaly in a feverish context), biological (systemic inflammatory response syndrome) and imaging (ultrasound or computed tomography) arguments [11] . Among morphological examinations, ultrasound holds a preponderant place in making it possible to make a positive diagnosis, to guide the etiological diagnosis, to assist in treatment by guiding sampling and drainage and to monitor the involution of fluid collections [1] [12] .

Medical treatment alone, consisting of an antiparasitic drug, metronidazole, with or without antibiotics, is often effective in achieving a cure. However, in some cases, ultrasound-guided drainage is of great benefit and surgery may be necessary [11] [13] [14] , especially in our context where the use of modern medicine is often late. By making an early diagnosis and implementing early correct treatment [15] , liver abscesses can be benign pathologies with a low mortality rate. The prognosis may be reserved due to late management or the presence of an immunosuppressive comorbidity or an underlying biliary pathology [4] [7] [16] .

Updated data on liver abscesses, in this era of antibiotic resistance, progress in interventional radiology, and the challenge of access to quality early care in our context are rare. Hence the conduct of this study, the objective of which was to describe the diagnostic, therapeutic and progressive aspects of liver abscesses at the Sourô Sanou University Hospital Center (CHUSS).

This study has some limitations:

Notwithstanding these shortcomings, this study allowed us to obtain results that could serve as a springboard for a more in-depth study. These results will be discussed in this section.

At the end of the thirty-six years of this study, 1767 patients were hospitalized, including 23 cases of liver abscess, representing an average annual frequency of 5.7 cases. This is a relatively rare pathology in our context. This rarity of liver abscess is also reported in the sub-region and in other African countries, with annual frequencies varying according to the study setting [9] [17] and the amoebic or pyogenic etiology ranging from 1 case/year in the studies of Bignoumba and Bouglouga [2] [16] to more than 5 cases/year [4] [5] . This rarity of abscess cases in this study could be explained by a selection of patients who are often treated in peripheral health centers of the city or in other localities, and are only referred to the University Hospital in the event of failure of the initial traditional or modern therapy.

The population was predominantly male, with a sex ratio of 2.8. Several authors agree that men are more affected, both for amoebic and pyogenic abscesses [3] [18] [19] , 55 to 60% of cases, according to Rossi et al. [6] , reaching 70 and 90% in the respective studies of Thioub and Diallo [9] [17] . This male predominance could be explained by the fact that men are more exposed to identified risk factors such as chronic alcoholism and smoking [9] [17] . The average age of the patients was 37.8 years ± 16.2 years, with extremes of 15 and 73 years. This would be the prerogative of young adults according to several studies in Sub-Saharan Africa [16] [17] . And other authors agree that the frequency would increase with age [6] [7] . Indeed, the older we get, the more certain comorbidities are associated with a progressive decline in immunity, creating a favorable environment for infections.

In terms of diagnosis, a pathological background and/or history was found in 21 patients (91.3%), dominated by intestinal amoebosis and regular alcohol consumption in 13 (56.5%) and 11 (47.8%) patients respectively. The medical risk factors for the occurrence of liver abscesses reported in the literature include dysentery [17] , chronic alcoholism, chronic liver disease, immunosuppression or diabetes, all possible causes of the weakening of the immune system [6] [17] [19] . Thus, Bignoumba et al. reported a background of chronic alcoholism (62.5%), diabetes (12.5%) and HIV infection (6.3% of patients) [2] . Clinically, the classic Fontan triad (painful hepatomegaly in a feverish context) was found upon admission in 21 patients (91.3%). Fever was present in all patients with right hypochondrium pain of heaviness type in 21 patients (91.3%). Hepatomegaly was present in 22 patients, or 95.7% of cases.

These data are consistent with findings in other studies in the literature [2] [4] [13] . Badaoui et al. reported a Fontan triad in 14 out of 19 cases of pyogenic liver abscess [4] . According to Rossi et al., the typical clinical picture includes fever (73% - 93%), right hypochondrium pain (45% - 80%) and painful hepatomegaly (30–50%) [6] . Bignoumba et al. reported right hypochondrium pain (93.8%), fever (68.8%) and hepatomegaly (68.8%) [2] . The deterioration in general condition found in more than 50% of patients could be explained by the late consultation, the inaccessibility of imaging in certain areas and the prior self-medication carried out by patients before consulting. In biology, hyperleukocytosis was observed in the blood count of all patients, while an increase in the sedimentation rate and CRP was observed in 18 patients (78.3%). The amoebic serology requested in one patient was positive. Hyperleukocytosis, anemia, high CRP, significant amoebic serology, positive blood culture and positive cytobacteriological examination of pus are also the findings reported in other African studies [2] [9] [17] . In our context, the costs of examination and treatment are at the expense of patients and their families, which is often a limiting factor for carrying out certain explorations (blood culture, amoebic serology), especially when they are not carried out in the public health structure where the patient is hospitalized.

Ultrasound revealed a single or multiple abscess in 9 and 14 patients respectively. The location was predominantly in the right lobe (21 patients, or 91.3% of cases) as in the literature. These data are consistent with those in the literature, where the predominance of single abscesses is reported, which are in favor of an amoebic etiology, a frequent parasitosis in the tropics [2] [9] [20] . The most representative etiology in our study was amoebic in 78% of cases. However, it should be taken into account that pyogenic abscesses require more expensive diagnostic means. The predominant location was in the right hepatic lobe (91.3%), in line with most of the reported results [3] [5] [17] . This is probably related to the fact that it constitutes a much larger tissue mass than that of the left lobe, and that the flow from the superior mesenteric vein would flow electively towards the right lobe [21] .

Regarding treatment, all patients received medical treatment associated or not with instrumental and/or surgical treatment. The most commonly used drugs were antiparasitics and antibiotics, the main ones being imidazoles alone or associated with a third-generation cephalosporin, in 7 (30.4%) and 15 patients (65.2%) respectively. These data are in line with the results reported in other studies: medical treatment, based on antiparasitics such as metronidazole (100%), associated or not with other antibiotics, is very effective [16] [17] [22] . The majority of abscesses in this study being of amoebic origin, due among other things to the frequency of intestinal amoebiasis in our context, is probably the main cause of favorable response under metronidazole, in monotherapy or dual therapy with another antibiotic. Unlike the study by Bignoumba et al., where 100% of abscesses were drained by ultrasound-guided percutaneous aspiration, supplemented by surgical drainage in 12.5% of cases [2] , in our study, ultrasound-guided drainage was performed in 12 (80%) patients and surgical drainage was necessary in only 2 cases (8.9%). Medical treatment is systematic, but not surgery, which is reserved for complications [9] [17] . Indeed, the treatment of hepatic abscesses of less than 3 to 5 cm, especially if they are multiple, can be done by antibiotic therapy without drainage, with a favorable outcome. Ultrasound-guided percutaneous puncture, diagnostic before drainage, and therapeutic, in association with antibiotic therapy, was an effective, less invasive method, with little discomfort for patients.

In terms of evolution, the average hospital stay was 9.9 days with extremes ranging from 4 to 21 days and a normalization of temperature in all our patients. Bouglouga and al. reported an average hospitalization time of 16.2 days [16] . The evolution was favorable, with a cure in 19 patients (82.6%) and a fatal outcome in 4 patients including 2 cases of immunosuppression by HIV infection, one diabetic patient and another with no reported pathological history. Bignoumba and Thioub reported 6.3% and 8% of cases of death respectively [2] [17] . The prognosis is generally good, depending on the diagnostic time, the underlying terrain and the early management [9] [13] . Thus, mortality concerned cases of immunosuppression and association of comorbidities, risk factors for death.

This study shows that the clinical picture of liver abscess remains dominated by the classic Fontan triad. At the paraclinical level, inflammation was almost present in all patients and the abscess was single or multiple. Medical treatment was based primarily on metronidazole alone or associated with C3G, supplemented by instrumental or surgical treatment. The outcome was favorable in the majority of cases. An improvement in etiological diagnosis requires accessibility to amoebic serology, bacteriological examinations and interventional radiology in our context.

DATA COLLECTION FORM

I. FILE NUMBER: ……………

II. EPIDEMIOLOGY :

III. BACKGROUND:

IV. CLINICAL DATA

V. PARACLINICAL DATA

VI. ETIOLOGIES

VII. TREATMENT

If Yes:

If Yes: