Case report: amoebic liver abscess complicated by a hepatoduodenal fistula

Amoebic liver abscess (ALA) is a common extra-intestinal presentation of amoebiasis caused by Entamoeba histolytica. The liver abscess may be complicated by rupture into adjacent structures. Common organs involved include thorax, peritoneum and pericardium. Rupture into the gastrointestinal tract is extremely rare. We report a patient who developed a hepatoduodenal fistula complicating an amoebic liver abscess. Suspicions were raised on finding air in the liver abscess on ultrasound scanning. Diagnosis was confirmed on a water-soluble (Gastrografin) swallow (Fig. 1 a,b). Complications of ALA are associated with a high morbidity and mortality and early diagnosis is important. To our knowledge only one previous case of a hepatoduodenal fistula complicating an ALA with radiological confirmation has been reported.