MANAGEMENT OF RUPTURED AMOEBIC LIVER ABSCESS: 22-YEARS EXPERIENCE
Abstract
Background: Amoebiasis affects approximately 10% of the population all over the world. Amoebicliver abscess (ALA) is the commonest complication of amoebiasis affecting 3–9% victims. It is anancient disease as Hippocrates notified large hepatic abscesses likely to be amoebic abscesses.Objective of this study was to see the efficacy of conservative treatment in the management of rupturedamoebic liver abscess. Methods: Record of 1,083 patients of amoebic liver abscess, who were treatedand managed at Liaquat University Hospital between January 1986 and December 2007, was reviewedretrospectively. Amongst these, 36 (3.32%) patients, found to have intra-peritoneal rupture of the liverabscess were included in this study. The record of these patients was reviewed. The patients weredivided into group A and B depending upon the mode of treatment employed. Group A included 16(44.44%) patients in whom exploratory laparotomy was performed while group B included 20(55.55%) patients who were treated conservatively. Results: Group A consisted of 16 (44.4%) patientswho underwent laparotomy for acute peritonitis due to non-availability of ultrasound in the initialperiod of the study. In group B, all twenty patients were treated conservatively after a diagnosis ofruptured amoebic liver abscess made by ultrasound guided percutaneous aspiration of pus. Thesepatients were treated with ultrasound guided aspiration of pus with placement of peritoneal drain underlocal anaesthesia. Six patients in group A died compared to one patient in group B. the overall mortalityof ruptured amoebic liver abscess was 19.4%. It was higher in patients treated surgically (37.5%)compared to patients who were treated conservatively (5%). Conclusion: Conservative treatment is aneffective modality of treatment for ruptured liver abscess with minimum mortality and mortality ifdiagnosis is made early.Keywords: Amoebic liver abscess, intra-peritoneal rupture, exploratory laparotomy, conservativetreatment, mortality and morbidityReferences
Russel RCG: The Liver. In ( Eds) Mann CV, Russel RCG,
Williams NS. Short Practice of Surgery. 22nd edn. London:
Chapman and Hall; 1995.701–20.
Peters RS, Gitlin N, Libke RD. Amoebic Liver Diseases. Ann
Rev Med1982;32:161–74.
Toyokazu K, Yuji I, Susumu N. Ruptured amebic liver abscess.
HPB Surgery 1990;3(1):21–8.
Sharma MP, Ahuja V. Amoebic Liver Abscess. J Indian Acad
Clin Med 2003;4(2):107–11.
Zafar A. Amoebic liver abscess: a comparative study of needle
aspiration versus conservative treatment. J Ayub Med Coll
Abbottabad 2002;14(1):10–2.
Satti SA, Ahmed SI, Satti TM, Habib M, Naseemullah M.
Amoebic Liver Abscess: An Eight Year Analysis. J Rawal
Med Coll. 2001;5(2):73–5.
Natarajan A, Souza RE, Lahoti NG, Candrakala SR. Ruptured
liver abscess with fulminant amoebic colitis: case report with
review. Trop Gastroenterol 2000;21(4):201–3.
Eggleston FC, Handa AK, Verghese M. Amoebic peritonitis
secondary to amoebic liver abscess. Surgery 1982;91:46–8.
Tandon N, Karak PK, Mukhopadhyay S, Kumar V. Amoebic
liver abscess: Rupture into retroperitoneum Abdominal
Imaging 1991;16(1):240–2.
De Bakey ME, Jr. JG. Hepatic abscesses, both intrahepatic and
extrahepatic. Surg Clin North Am 1977;57:325–37.
Archampong EQ. Peritonitis with amoebic abscess. Br J Surg
;59:179–81.
Wallace RJ Jr, Greenberg SB, Lau JM, Kalchoff WP, Mangold
DE, Martin R. Amoebic peritonitis following rupture of an
amoebic liver abscess. Successful treatment of two patients.
Arch Surg 1978;113(3):322–5.
Rehan TM, Tariq NA, Ahmed M, Sohail A, Bhatti SZ.
Amoebic Liver Abscess: Analysis of Two Hundred Cases:
Presentation and Management. Ann King Edward Med Coll
;4(3):41–3.
Khan AZ, Akhtar S, Usman L, Ahmad F. Management of
Amoebic Liver Abscess. Ann King Edward Med Coll
;7(2):143–4.
Oschner A, DeBakey ME. Amoebic hepatitis and hepatic
abscess: an analysis of 181 cases with review of literature.
Surgery 1943;13:612–49.
Iqbal J, Yamin SA. Laparoscopic Drainage of Liver Abscess. J
Coll Physicians Surg Pak 2001;11:636–8.
Mushtaq M, Nandwani GM, Khan A. Clinical presentation of
liver abscess. J Surg Pak 2002;7(3):43–6.
DeBakey ME, Oschner A. Hepatic amoebiasis: a 20 years
experience and analysis of 263 cases. Surg Gynecol Obstet
;92:209–31.
Giorgio A, Tarantino L, Mariniello N, Francica G, Scala
E, Amoroso P, et al. Pyogenic liver abscesses: 13 years of
experience in percutaneous aspiration with US guidance.
Radiology 1995;195(1):122–4.
Hashimoto L, Hermann R, Grundfest-Broniatowski S.
Pyogenic hepatic abscess: results of current management. Am
Surg 1995;61:407–11.
Channa A, Siddiqui A. Laparoscopic drainage of ruptured liver
abscess. J Surg Pak 2005;10(1):36–8.
J Ayub Med Coll Abbottabad 2010;22(2)
http://www.ayubmed.edu.pk/JAMC/PAST/22-2/Memon.pdf 99
Ghori RA, Memon MA, Asghar P, Memon H. Amoebic liver
abscess and its complications. Biomedica 1998;14:78–83.
Muhammah W, Iqbal S, Iman NU, Rehman KU, Rehman SU.
Presentation and management of liver abscess. J Postgrad Med
Inst 2004;18(2):273–41.
Bukhari AJ, Khanum A, Bhutta A, Abid KJ, Mian ZA. Role of
ultrasonography in amoebic liver abscess. Pakistan Postgrad
Med J 2002;13(4):165–9.
Ka MM, Ndiaye MF, Fall B, Niang EH, Herve P, Niang A, et
al. Contribution of echography in the diagnosis of ruptured
liver abscess. Dakar Med 1991;36(2):127–32.
Adam EB, McLeod IN. Invasive amoebiasis II, amoebic liver
abscess and its complications. Medicine 1977;56:324–34.
Maltz G, Knauer CM. Amoebic liver abscess: a 15-year
experience. Am J Gastroenterolgy 1991;86:704–10.
Juimo AG, Gervez F, Angwafo FF. Extraintestinal amoebiasis.
Radiology 1992;182:181–3.
Wee A, Nilson B, Yap I, Chong SM. Aspiration cytology of
liver abscesses with an emphasis on diagnostic pitfalls. Acta
Cytologica 1995;39:453–62.
Bhukari AJ, Abid KJ. Amoebic liver abscess: clinical
presentation and diagnostic difficulties. Kuwait Med J
;35(3):186–6.
Papavramidis TS, Sapalidis KG, Pappas D, Karagianopoulou
G, Trikoupi A, Ch Souleimanis, et al. Gigantic hepatic
amoebic abscess presenting as acute abdomen. J Med Cae
Reports 2008;2:325
Lamont NM, Pooler NR. Hepatic amoebiasis. Quart J Med.
;27:389–412.
Paul M. New concepts on amoebic abscess of the liver. Brit J
Surg 1960;47:502–14.
Singh KP, Sreemannarayana J, Mehdiratta, KS. Intra-peritoneal
rupture of amoebic liver abscess. Int Surg. 1977;62:432–4.
Sarda AK, Bal S, Sharma AK, Kapur MM. Intraperitoneal
rupture of amoebic liver abscess. Br J Surg 1989;76(2):202–3.
Karim A, Haleem A, Qayyum A, Ansari NUH, Iqbal S. A
study of medical management of liver abscess. Biomedica
;20(1):52–2.
Dietrick RB. Experience with liver abscess. Am J Surg
;147:288–91.
Pitt HA, Zuidema GD. Factors influencing mortality in the
treatment of pyogenic liver abscess. Surg Gynaecol Obstet
;140:228–34.
Perera MR, Kirk A, Noone P. Presentation, diagnosis and
management of liver abscess. Lancet 1980;316:629–32.
Miedema BW, Dineen P. The diagnosis and treatment of
pyogenic liver abscesses. Ann Surg 1984;200:328–35.
Farges O, Leese T, Bismuth H. Pyogenic liver abscess: An
improvement in prognosis. Br J Surg 1988;75:862–5.
Verlenden WL, Frey CF. Management of liver abscess. Am J
Surg 1980;14:53–9.
Karatassas A, Williams JA. Review of pyogenic liver abscesses
at the Royal Adelaide Hospital, 1980. Aust NZ J Surg
;60:893–7.
Mischinger HJ, Hauser H, Rabl H, Quehenberger
F, Werkgartner G, Rubin R, et al. Pyogenic liver abscess:
Studies, therapy and analysis of risk factors. World J Surg
;18:852–8.
Eggleston FC, Handa AK, Verghese M. Amoebic peritonitis
secondary to amoebic liver abscess. Surgery 1982;91:46–8.
Downloads
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.