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Gigantic hepatic amebic abscess presenting as acute abdomen: a case report.

Papavramidis TS, Sapalidis K, Pappas D, Karagianopoulou G, Trikoupi A, Souleimanis CH, Papavramidis ST - J Med Case Rep (2008)

Bottom Line: It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases.A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII.Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, A.H.E.P.A. University Hospital of Thessaloniki, Aristotle's University of Thessaloniki, Thessaloniki, Macedonia, Greece. spapavra@med.auth.gr

ABSTRACT

Introduction: Amebiasis is a parasitic disease caused by Entamoeba histolytica. It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases. Liver abscess is the most common extra-intestinal manifestation. The large number of clinical presentations of amebic liver abscess makes the diagnosis very challenging in non-endemic countries. Late diagnosis of the amebic abscess may lead to perforation and amebic peritonitis, resulting in high mortality rates.

Case presentation: This report describes a 37-year-old white man, suffering from hepatitis B, with a gigantic amebic liver abscess presenting as an acute abdomen due to its rupture. Rapid deterioration of the patient's condition and acute abdomen led to an emergency operation. A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII. Surgical drainage of the hepatic abscess was performed; two wide drains were placed in the remaining hepatic cavities and one on the right hemithorax. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The diagnosis of amebic abscess was made by the pathologists who identified E. histolytica in the debris.

Conclusion: Acute abdomen due to a ruptured amebic liver abscess is extremely rare in western countries where the parasite is not endemic. Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan with enhancement media showing the hepatic abscess.
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Figure 1: Computed tomography scan with enhancement media showing the hepatic abscess.

Mentions: The next day, the patient presented with dyspnea and auscultation revealed diminished breath sounds with diminished vocal resonance in the right hemithorax. A chest X-ray revealed a pleural effusion in the right hemithorax. Computed tomography (CT) scanning of the chest and abdomen revealed a pleural effusion and a liver abscess (Figure 1). The abscess measured 14 × 9 × 7 cm, occupying a great percentage of the right lobe. An echogram of the liver showed septae within the abscess and for this reason echo- or CT-guided drainage was avoided. An operation was scheduled for the following day, but a rapid deterioration of the patient's clinical condition was observed that evening. The patient was febrile (oral temperature 39.2°C) with hypotension, tachypnea (32 breaths/minute) and tachycardia (110 beats/minute) and signs of an acute abdomen. Therefore, emergency surgery was deemed necessary. During exploratory laparotomy, a large volume of free fluid (~2200 ml) together with debris was found on entry into the peritoneal cavity. A rupture of the hepatic abscess at the position of segment VIII was found <Authors: and surgical drainage of the hepatic abscess (that contained many septae) was performed and two wide drains (32G) were placed in the remaining hepatic cavity. Finally, a thoracic drain tube (Büllau) was placed and gave only yellowish reactive fluid. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The cultures of the pus were negative for any microorganisms. The diagnosis of an amebic abscess was made by the pathologists who identified E. histolytica in the debris (Figure 2). The patient was discharged receiving metronidazole (Flagyl, Rhone Poulenc Rorer) 500 mg three times a day.


Gigantic hepatic amebic abscess presenting as acute abdomen: a case report.

Papavramidis TS, Sapalidis K, Pappas D, Karagianopoulou G, Trikoupi A, Souleimanis CH, Papavramidis ST - J Med Case Rep (2008)

Computed tomography scan with enhancement media showing the hepatic abscess.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572068&req=5

Figure 1: Computed tomography scan with enhancement media showing the hepatic abscess.
Mentions: The next day, the patient presented with dyspnea and auscultation revealed diminished breath sounds with diminished vocal resonance in the right hemithorax. A chest X-ray revealed a pleural effusion in the right hemithorax. Computed tomography (CT) scanning of the chest and abdomen revealed a pleural effusion and a liver abscess (Figure 1). The abscess measured 14 × 9 × 7 cm, occupying a great percentage of the right lobe. An echogram of the liver showed septae within the abscess and for this reason echo- or CT-guided drainage was avoided. An operation was scheduled for the following day, but a rapid deterioration of the patient's clinical condition was observed that evening. The patient was febrile (oral temperature 39.2°C) with hypotension, tachypnea (32 breaths/minute) and tachycardia (110 beats/minute) and signs of an acute abdomen. Therefore, emergency surgery was deemed necessary. During exploratory laparotomy, a large volume of free fluid (~2200 ml) together with debris was found on entry into the peritoneal cavity. A rupture of the hepatic abscess at the position of segment VIII was found <Authors: and surgical drainage of the hepatic abscess (that contained many septae) was performed and two wide drains (32G) were placed in the remaining hepatic cavity. Finally, a thoracic drain tube (Büllau) was placed and gave only yellowish reactive fluid. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The cultures of the pus were negative for any microorganisms. The diagnosis of an amebic abscess was made by the pathologists who identified E. histolytica in the debris (Figure 2). The patient was discharged receiving metronidazole (Flagyl, Rhone Poulenc Rorer) 500 mg three times a day.

Bottom Line: It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases.A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII.Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, A.H.E.P.A. University Hospital of Thessaloniki, Aristotle's University of Thessaloniki, Thessaloniki, Macedonia, Greece. spapavra@med.auth.gr

ABSTRACT

Introduction: Amebiasis is a parasitic disease caused by Entamoeba histolytica. It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases. Liver abscess is the most common extra-intestinal manifestation. The large number of clinical presentations of amebic liver abscess makes the diagnosis very challenging in non-endemic countries. Late diagnosis of the amebic abscess may lead to perforation and amebic peritonitis, resulting in high mortality rates.

Case presentation: This report describes a 37-year-old white man, suffering from hepatitis B, with a gigantic amebic liver abscess presenting as an acute abdomen due to its rupture. Rapid deterioration of the patient's condition and acute abdomen led to an emergency operation. A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII. Surgical drainage of the hepatic abscess was performed; two wide drains were placed in the remaining hepatic cavities and one on the right hemithorax. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The diagnosis of amebic abscess was made by the pathologists who identified E. histolytica in the debris.

Conclusion: Acute abdomen due to a ruptured amebic liver abscess is extremely rare in western countries where the parasite is not endemic. Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.

No MeSH data available.


Related in: MedlinePlus