Amebic liver abscess. The surgeon's role in management

Hepatic amebic abscess presented as an acute abdominal illness in 71 patients seen at the Harbor-UCLA Medical Center during the past 10 years. Most of the patients were young, Mexican and male, and half had coexistent medical diseases. The correct diagnosis was made by ultrasonography in 27 patients, laparotomy in 6, and radionuclide scan in 38. More than half (38 patients) were diagnosed accurately within 24 hours of admission. Sixty-seven abscesses were located in the right or both lobes; only 4 were limited to the left lobe, all of which had caused perforation. Operative findings in 20 patients were ruptured abscess in 12 and unruptured abscess in 2; abscesses were missed during exploration in 6 patients, one of whom had acute cholecystitis and another, a small bowel infarction. Other complications were intrathoracic rupture in four and intrapericardial rupture in one. Metronidazole was successful as initial drug therapy in 64 patients. Ultrasonographically-guided percutaneous drainage was used as a diagnostic and therapeutic adjunct to management in 15 patients. In a metropolitan population, the surgeon must consider amebic abscess in the evaluation of a febrile patient with right upper quadrant illness. With ultrasonography or radionuclide scanning, he can establish a reliable diagnosis in 24 hours. Although medical therapy is effective, surgery is required in 20 percent of patients for drainage of the ruptured abscess or treatment of a coexistent surgical condition. An unruptured abscess should be sought in an apparently negative exploration. A solitary abscess of the left lobe is rare but has a particular propensity to cause perforation.