Azhar Jawaid Bukhari.
Ruptured Amebic Liver Abscess.
J Coll Physicians Surg Pak Jan ;13(3):159-60.

A 20 years old male, with history of Pain which started 15 days ago from RUAQ but later involved the entire abdomen, but still the intensity was more in the RUAQ. The pain was aggravated by coughing and movements, and accompanied by fever, which was relieved temporarily by taking analgesics. He had anorexia in addition to vomiting on taking anything. He had no other complaints except dyspnea on routine activity. US guided needle aspiration of abscess like hepatic lesion, revealed 100 ml of `anchovy sauce`. Microscopic examination was not available. Abdominal ultrasound revealed an abscess cavity 7x8 cm in the right lobe of liver communicating with a subhepatic, well walled off collection. All the clinical findings and investigations were consistent with ruptured ALA. The patient was resuscitated and intravenous metronidazole (500 mg, 8 hourly) and cefuroxime (750 mg, 8 hourly) after aspiration were started and continued until the report of culture and sensitivity was available. Under US guidance, both the cavities were aspirated as completely as possible and two pigtail catheters, No. 10 F, were placed by Seldinger`s method in each cavity. The brownish aspirate revealed necrotic tissue debris. No E. histolytica, pus cells or neutrophils were found. Gram`s staining and bacterial culture were negative. Fever settled within the next 48 hours and pain disappeared, however, tenderness persisted for another 3 days. The patient could tolerate soft low residue diet on the 3rd day. The laboratory parameters showed a settling trend. The main cavity was reduced to 2 x 3 cm. on 15th day with cessation of discharge and the catheter was removed. Metronidazole was continued for another 10 days. The six months follow- up of the patient did not reveal any recurrence of disease or abnormality.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com