Perforated amebic liver abscesses: successful percutaneous treatment

Perforation of hepatic amebic abscess is associated with high morbidity and may result in death. Traditional treatment has been emergency surgery. The authors report successful percutaneous drainage of perforated hepatic amebic abscesses in five severely ill patients. These perforations resulted in abscesses in the subhepatic space, pelvis, chest, right and left paracolic gutters, lesser sac, retroperitoneum, and flank. A total of ten intrahepatic abscesses also were drained in these patients. Catheter drainage lasted from 7 to 34 days and was combined with metronidazole therapy; the latter had been used for 1 week in two patients and in one patient for 2 days without success before drainage. Associated fistulas were demonstrated to the bile ducts, duodenum, and colon; all healed spontaneously. This experience suggests an expanded use of catheter drainage for perforation, a serious complication of amebic abscess.