Amoebic liver abscess: presentation and complications

Abstract

Background: Amoebic liver abscess (ALA) is the most common inflammatory space occupying lesion of the liver. It has a highly variable presentation causing diagnostic difficulties. Untreated, complicated ALA has high morbidity and mortality.

Objective: To study the various types of clinical presentation and complications of ALA in order to establish early diagnosis and prevent complications.

Materials and methods: A prospective study was conducted in the Department of Surgery of Calcutta National Medical College and Hospital from July 2005 to June 2008. All patients with a confirmed diagnosis of ALA during this period were included in the study.

Results: Seventy-two patients with 76 ALAs were studied over a 3-year period. The age ranged from 21 to 72 years (mean age being 43.64 years). There were 66 males (91.67% of the patients) and 6 females (8.33% of the patients). The (31-40 years) age group showed the highest incidence consisting of 40.28% of the cases. Pain was located most commonly in the right hypochondrium in 60 patients (83.33%). Fever was observed in 58 patients (80.56%). Solitary abscess cavity was present in 68 patients (94.44%). The right lobe alone accounted for 65 (85.53%) of the abscesses. The most common echo pattern encountered in ultrasonography was the echorich pattern in 54 (71.05%) abscesses. Forty-four patients (61.11%) gave history of alcohol consumption. Diagnosis was missed in 21 patients (29.17%), particularly in those with atypical presentations. The most common complication was pleuropulmonary in 24 patients (33.33%), followed by intraperitoneal rupture in 19 patients (26.39%). Other complications were jaundice (n = 11), ascites (n = 9), subhepatic effusion (n = 7), subphrenic abscess (n = 3) and intrapleural rupture (n = 2). Ultrasonography was useful in diagnosing ALA. Despite successful therapy 23 patients (31.94%) had residual abscess cavities on ultrasonography even after 6 months.

Conclusion: In an endemic area a patient presenting with lower chest or upper abdominal pain along with tender hepatomegaly should raise the suspicion of ALA. Sonography remains an important tool in the diagnosis of ALA.

Keywords: ALA; Complications; Diagnosis.