Amebic liver abscess rupturing into the lesser omentum space

A case of an amebic abscess localized in the lesser omentum is reported. There was no sign of a liver abscess in the imaging examination or the operative findings. However, it is likely that the amebic infection occurred after a liver abscess ruptured into the abdominal cavity. Early diagnosis and therapy are required when an abscess of unknown origin borders the liver, given the possibility of amebic abscess.     

Analysis of 69 patients with amebic liver abscess

All 69 patients with amebic liver abscess that we treated in 1981–1992 were studied retrospectively. Men predominated by a 101 ratio. Of our 227 patients with amebiasis, some 30% yearly had liver involvement. The incidence peaked in 1988, decreasing later but increasing again in 1992. Most patients were 30–50 years old, the overall mean age being 45 years (range, 22–79), and decreasing with time. Patients with the related factors of travel abroad, positive results of a test forTreponema pallidum hemagglutination, and homosexuality have increased in number in recent years. Fever, abdominal pain, and hepatomegaly were the most frequent findings, and 39 patients had neither bloody stools nor diarrhea. Only 8 patients had had amebiasis previously. A solitary abscess in the right lobe of the liver was found in 40 patients.Eniamoeba histolytica was found in the stool of 31 patients and in the pus of 39 patients. Sixty-one patients had positive results for an amebic serological test(s). The abscesses ruptured into the peritoneal cavity in 4 patients. All patients received metronidazole. Percutaneous or surgical drainage (or both) was done in 62 patients. The outcome was good, with 1 exception, and only 2 patients had recurrences.     

替硝唑治疗阿米巴肝脓肿的疗效观察

目的观察替硝唑对阿米巴肝脓肿的临床疗效。方法以每日顿服替硝唑２．０ｇ，５日疗法治疗３３例阿米巴肝脓肿患者，并与甲硝唑１４日疗法治疗３１例阿米巴肝脓肿患者进行比较。结果替硝唑组患者体温恢复正常时间（３．７±０．５天），平均住院天数（２４．３±１．５天）及总有效率（７８．８％）与甲硝唑组比较，差异无显著性（Ｐ＞０．０５）。但替硝唑组患者脓腔缩小所需时间较短，肝区疼痛消失较早，不良反应亦比甲硝唑组较少（Ｐ＜０．０５）。结论替硝唑是一种治疗阿米巴肝脓肿的新的良好药物     

Predictive factors for early aspiration in liver abscess

AIM： To determine the predictive factors for early aspiration in liver abscess. METHODS： A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 （68%） patients, pyogenic in 200 （21%）, indeterminate in 73 （8%） and mixed in 32 （3%）. Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS： A total of 966 patients, 738 （76%） male, mean age 43 ± 17 years, were evaluated： 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were： age≥ 55 years, size of abscess ≥5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION： Patients with advanced age, abscess size 〉 5 cm, both lobes of the liver involvement and duration of symptoms 〉 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.     

The role of percutaneous transhepatic abscess drainage for liver abscess

To evaluate the efficacy of percutaneous transhepatic abscess drainage (PTAD) as an initial choice of treatment for liver abscess, the medical records of 28 patients with liver abscess were retrospectively analyzed. The patients were predominantly men (23 of 28) with a mean age of 59 years (range, 19—86 years). Their chief complaints were fever (86%), right hypochondralgia (32%), and jaundice (11%). Fifteen of the 28 patients (54%) had hepatobiliary and pancreatic carcinoma, and 31% had postoperative liver abscess. PTAD was performed in 23 patients and surgical drainage in 5. The overall success rate for PTAD was 83%. The success rate for PTAD for patients with multiple abscesses was 83% (5 of 6), compared with a success rate of 82% (14 of 17) for patients with solitary abscess. The prognostic factors for survival were cancer and sepsis and the mortality rate for patients with cancer was 40% (6 of 15) while the mortality rate for patients with sepsis was 56% (5 of 9). As a complication of drainage, 1 patient (4%) in the PTAD group had pleural abscess due to the transpleural puncture. Our findings support the use of PTAD as the primary treatment for liver abscess, as it is safe and effective irrespective of the number of abscesses and the patient's condition.     

Amebic liver abscess

Opinion statement Amebic liver abscess should be suspected in travelers returning from endemic areas or in immunocompromised patients who present with fever, right upper quadrant pain, hepatomegaly, and a liver lesion on an imaging study. Rapid initiation of therapy without serologic confirmation of infection, if necessary, is important to minimize complications. Metronidazole is given orally or intravenously for 14 days. The drug is generally well tolerated and leads to resolution of symptoms in most patients within 2 to 3 days. It is effective against luminal cysts in only 50% of patients and, therefore, must be followed by a course of treatment with paromomycin (Humatin; Parke-Davis, Morris Plains, NJ) or another luminal antiamebic agent to eradicate the parasite. Image-guided drainage of an amebic liver abscess is indicated in patients who do not respond to antimicrobial therapy or who are at risk of abscess rupture. Surgery is reserved for patients with a ruptured abscess. Although medical therapy is generally successful in the treatment of infection caused by Entamoeba histolytica, the development of potent vaccines will be needed for worldwide eradication of disease attributable to E. histolytica.     

Amebic liver abscess

Summary Clinical experiences with the patient in this report confirm the effectiveness of therapy with emetine and chloroquine in the treatment of amebic liver abscesses. Needle aspiration of accessible abscesses is desirable.     

Amebic liver abscess

Amebic liver abscess (ALA) highly endemic in most developing tropical countries is being encountered more frequently in other geographical areas maybe secondary to increased travel to areas where the disease is endemic as well as in the homosexual population. We report a classical clinical case of ALA in a 44 years old man diagnosed by ultrasound and positive seroameba titers who responded to oral imidazoles.     

Amebic liver abscess

Amebiasis is a widespread parasitic disease caused by Entamoeba histolytica. This protozoan organism is the third leading parasitic cause of death in the developing world and is an important health risk to travelers in endemic areas. Amebiasis most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients may develop intestinal invasive disease or extraintestinal disease-amebic liver abscess being the most common extraintestinal manifestation. This article reviews epidemiologic features, pathophysiology, clinical features, diagnostic tests, imaging studies, treatment of amebic liver abscess, and prevention measures.     

Hepatectomy for pyogenic liver abscess

BackgroundCommensurate with the advances in diagnostic and therapeutic radiology in the past two decades, percutaneous needle aspiration and catheter drainage have replaced open operation as the first choice of treatment for both single and multiple pyogenic liver abscesses. There has been little written on the place of surgical resection in the treatment of pyogenic liver abscess due to underlying hepatobiliary pathology or after failure of non-operative management.MethodsThe medical records of patients who underwent resection for pyogenic liver abscess over a 15-year period were retrospectively reviewed. The demographics, time from onset of symptoms to medical treatment and operation, site of abscess, organisms cultured, aetiology, reason for operation, type of resection and outcome were analysed. There were 49 patients in whom the abscesses were either single (19), single but multiloculated (11) or multiple (19). The median time from onset of symptoms to medical treatment was 21 days and from treatment to operation was 12 days. The indications for operation were underlying hepatobiliary pathology in 20% and failed non-operative treatment in 76%. Two patients presented with peritonitis from a ruptured abscess.ResultsThe resections performed were anatomic (44) and non-anatomic (5). No patient suffered a recurrent abscess or required surgical or radiological intervention for any abdominal collection. Antibiotics were ceased within 5 days of operation in all but one patient. The median postoperative stay was 10 days. There were two deaths (4%), both following rupture of the abscess.DiscussionExcept for an initial presentation with intraperitoneal rupture and, possibly, cases of hepatobiliary pathology causing multiple abscesses above an obstructed duct system that cannot be negotiated non-operatively, primary surgical treatment of pyogenic liver abscess is not indicated. Non-operative management with antibiotics and percutaneous aspiration/drainage will be successful in most patients. If non-operative treatment fails, different physical characteristics of the abscesses are likely to be present and partial hepatectomy of the involved portion of liver is good treatment when performed by an experienced surgeon.     

Nocardia liver abscess post liver transplantation—A rare presentation

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long‐term antibiotics for Nocardia infection.     

Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess

A 56-year-old Japanese man with hypertension presented with a 10 days history of high fever, right and left upper quadrant tenderness. An abdominal ultrasonography and computerized tomographic scan revealed a large collection in the right lobe of the liver that was consistent with an abscess. A drainage catheter was placed and purulent fluid was drained. Cultures of the fluid and blood were positive for a strain of ampicillin-resistant Klebsiella pneumoniae. Six days after admission, paraplegia and urinary retention were found. On the neurological examination, deep tendon reflexes of the lower extremities were absent bilaterally. Magnetic resonance imaging scan detected thoracic spinal epidural abscess and paraspinal abscess. He received the emergent decompressive laminectomy. Culture of surgical specimen grew ampicillin-resistant K. pneumoniae. The patient was treated with biapenem intravenously. Thereafter, clinical symptoms improved gradually and he was removed to the professional hospital to continue rehabilitation for gait disturbance on hospital day 147.     

Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.     

Ascaris liver abscess in children

Background Liver abscess in childhood is a very challenging subject both for patients and doctors. In India, pyogenic liver abscesses have been found mostly in children, especially in rural areas. Liver abscess due to wandering ascarids is a common complication in children in Kashmir, although it is rare outside. Methods The study was carried over a period of 10 years at Sheri-Kashmir Institute of Medical Sciences Srinagar India. Ten cases of liver abscesses due to wandering ascarids in children were encountered. The children were aged 2 years to 13 years. Results 70% of the children were from rural areas. All ten patients presented with fever, while three patients presented with peritonitis. Ultrasonography was the main tool of diagnosis. All ten patients were managed by open surgical drainage. Conclusion We conclude that Ascaris infestation should always be kept in mind while dealing with liver abscess in children.     

Pasteurella multocida lung and liver abscess in an immune-competent child

We report on a 20-month-old infant with a complicated lung and liver abscess caused by Pasteurella multocida after the child had been in close contact with a domestic cat. Surgical drainage confirmed lung and liver abscesses connected to each other, with involvement of the diaphragm.