Modified amoebic liver abscess: Case report / Absceso hepático amebiano modificado: reporte de un caso

Abstract We present the case of a 56-year-old black female patient from a rural area in the Morón municipality, Ciego de Ávila province, Cuba. She was admitted with symptoms of dysentery with several days of evolution and a later episode of high fever, compromised general status, and abdominal pain located in the right hypochondrium. Analytical studies reported leukocytosis with a predominance of polymorphonuclear cells, Entamoeba histolytica was found in the stool study. Abdominal ultrasound reported a mixed image of 110 x 84 mm in the upper right lobe of the liver, as confirmed by computed tomography. This image was interpreted as a possible liver abscess. The patient received antimicrobial treatment for four weeks without a good response, thus requiring surgical intervention. She evolved favorably and was discharged after 21 days.

Resumen Se presenta el caso de una paciente de raza negra de 56 años procedente de área rural de Morón, provincia Ciego de Ávila (Cuba), quien ingresa por cuadro clínico de disentería de varios días de evolución acompañado de fiebre, compromiso de su estado general y dolor abdominal en el hipocondrio derecho. Los estudios analíticos de laboratorio mostraron leucocitosis con predominio de neutrófilos y presencia de trofozoitos de Entamoeba histolytica en la materia fecal. La ecografía de abdomen reporto una imagen mixta de 110 x 84 mm en el lóbulo derecho del hígado y la tomografía confirmó la lesión que se interpretó como un posible absceso hepático. Se inició tratamiento antimicrobiano por un periodo de 4 semanas sin adecuada respuesta por lo que requirió tratamiento quirúrgico. Su evolución fue favorable con egreso a los 21 días.

Supra-Cath : A Life Saving Catheter.

Amebic liver abscesses are more likely to be solitary and more commonly located in the right hepatic lobe. Though uncommon, erosion usually from left lobe into the pericardium is the most dangerous complication of amebic liver abscess. We encountered an interesting case of an elderly male, who presented with features suggestive of cardiac temponade. We could demonstrate the left lobe abscess, pericardial effusion and also pericardial fistula on ultrasonography. Patient was successfully managed by percutaneous drainage of left lobe hepatic abscess by Supra- Cath, which also drained pericardial effusion with immediate symptomatic relief.

Amebic liver abscess: clinical presentation and diagnostic difficulties

To identify the symptoms and signs of amebic liver abscess [ALA] in our population in order to establish early diagnosis. Subjects and A prospective study was conducted in the Department of Surgery, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan, during the year 2000 to 2002 [2 1/2 years]. All patients with a confirmed diagnosis of A L A during this period were included in the study. The detailed history and relevant clinical data including investigations and daily progress were recorded on proforma, later analyzed and compared with other studies. Fifty-three patients with ALA, accounting for 0.5% of yearly hospital admission were included in this study. The age ranged from 10 to 60 years [mean 29 years]. The male to female ratio was 2.8 to 1. Upper abdominal pain occurred in 90%, right upper abdominal quadrant pain in 70%, radiation to tip of right shoulder in 10%, fever in 85%, co-incident diarrhea in 7.5% and concurrent pulmonary symptoms in 26%. The most common signs were tender hepatomegaly in 79%, and jaundice in 20.7%. Abscess ruptured in 3.8% due to delayed diagnosis, and ruptured despite treatment in another 3.8%. Diagnosis was missed in 28% of the patients particularly those with atypical presentations. Ultrasonography [US] was useful in diagnosing ALA. A L A has a highly variable presentation. Clinical diagnosis is difficult. Delayed diagnosis may result in rupture of abscesses. High index of clinical suspicion combined with US of abdomen is helpful in reaching an early diagnosis

Percutaneous catheter drainage of liver abscesses

Imaging-guided percutaneous catheter drainage of hepatic abscesses [PAD] was done in 39 patients. Amebic liver abscesses were diagnosed in 18 patients, where 17 patients had pyogenic liver abscesses and 4 patients had indeterminate abscesses. Right lobe abscesses were seen in 32 patients and left lobe abscesses were seen in 7 patients. PAD was successful in 36 patients [92.3%], emergency laparotomy was indicated in one case who developed clinical signs of peritonitis and in two cases the condition deteriorated due to insufficient catheter drainage with C.T. evidence of persistent abscess cavity and both were drained by open surgery. 1- year follow up was available for all patients with no reported abscess recurrence. Complications developed in 4 cases [10.3%] in the form of bacteraemia [3 cases] and pneumothorax [one case]. The catheter drainage time ranged from 3 to 35 days [mean = 16 days]. PAD of hepatic abscesses is an effective, relatively safe and permanent therapeutic method. It can be used as a safe alternative to surgery, except of there is an underlying liver disease

Diagnosis of liver abscess by ultrasound

Amoebic liver abscess is common in Pakistan whereas pyogenic abscess is more prevalent in the west. Timely diagnosis of the liver abscess significantly lowers the morbidity and mortality. Present study involves ultrasound examination of 200 consecutive patients in a five year period [September 1990 - August 1995] at civil teaching hospital, Abbottabad and private clinics. One hundred and ninety six patients [98%] had amoebic liver abscess. In a similar number of cases the abscess was solitary. Abscess was located in right hepatic lobe in 184 [92%] Majority of patients [76%] were males while 24% were females. Age of our patients was between 10-60 years and size of the lesion varied between 3-16 cm. Ultrasound has proved to be excellent imaging modality in the diagnosis liver abscess. In selected cases abscess can be aspirated or drained under ultrasound guidance

Ultrasonographic patterns of hepatobiliary mass lesions.

The study deals with an analysis of ultrasonographic (USG) patterns in 100 consecutive patients with hepatobiliary mass lesions. Amoebic liver abscess, carcinoma (CA) gall bladder and secondaries in liver comprised nearly 70% of cases. USG appearances in liver abscess, hepatoma, secondaries in liver and CA gall bladder were variable, but were characteristic in hydatid disease and congenital polycystic disease. Two patients with cholangiocarcinoma revealed dilated biliary channels with an intraluminal mass in common bile duct.

Ultrasonic evaluation of intra-abdominal abscesses.

This study describes the role of ultrasound in the evaluation of abdominal abscesses in children. A total of 41 abscesses were encountered in 36 patients (21 boys and 15 girls). The youngest patient was 1-month-old. Abscesses were localised at various sites (hepatic, renal, perirenal, paracolic, appendicular, pelvic, psoas, subphrenic, parietal), and of varied sonographic patterns (complex, anechoic, hypoechoic and containing uniform low level echoes). Most of them had irregular walls.

Amoebic liver abscess rupturing into the chest: ultrasonographic appearance.

Two cases of amoebic liver abscess perforating into chest are reported. Both patients were males in their twenties. They presented with right upper quadrant pain in abdomen in one case and right lower chest pain in second case. Ultrasonography demonstrated hypoechoic liver abscess in superior subdiaphragmatic part of the right lobe of liver, with communication through a hole in the diaphragm into the thoracic cavity in both the cases. Both these cases were diagnosed as cases of amoebic liver abscess perforated into chest on the basis of ultrasonographic findings and both of them showed good response to specific antiamoebic therapy.