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Massive amebic liver abscess--an unusual presentation
1Department of Surgery , University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi.
Summary
A large liver cyst caused by Entamoeba histolytica was surgically managed with a Roux-en-Y anastomosis. The patient recovered well after treatment with metronidazole.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Amebiasis is a parasitic infection caused by Entamoeba histolytica, typically affecting the colon but can manifest in extraintestinal sites like the liver.
- Hepatic amebic abscesses are a common extraintestinal manifestation, but large cystic presentations without typical abscess features are less frequent.
Observation:
- A 40-year-old woman presented with a large abdominal mass and menstrual irregularities.
- Imaging revealed a complex cystic lesion in the right abdomen, obscuring the right ovary.
- Surgical exploration identified a large cyst originating from the liver's right lobe with bilious aspirate.
Findings:
- The cyst wall was densely adherent to surrounding retroperitoneal structures, precluding complete surgical excision.
- Histopathological examination of the cyst wall revealed inflammatory granulation tissue and Entamoeba histolytica trophozoites.
- A Roux-en-Y jejunal loop was anastomosed to the cyst for drainage due to unresectable adherence.
Implications:
- This case highlights a rare cystic presentation of hepatic amebiasis requiring surgical intervention.
- Management involved a combination of surgical drainage and antiparasitic therapy (metronidazole).
- Successful treatment underscores the importance of considering amebiasis in cystic liver lesions, even with atypical presentations.