Amebic abscess of the liver: surgical aspects

During the past five years, ten documented cases of hepatic amebic abscess have required surgical intervention at Olive View Hospital, Van Nuys, California. Three of the patients underwent laparotomy when an hepatic abscess ruptured into the peritoneal cavity, and two required surgical intervention when an abscess invaded adjacent organs. Another abscess continued to enlarge despite metronidazole therapy and still another became superinfected with bacteria. In the remaining three patients, surgical procedure would have been avoided if the correct diagnosis had been made. In fact, the preoperative diagnosis in five cases was acute appendicitis. All patients survived. The incidence of Entamoeba histolytica infestation is increasing in our community. Although most patients rapidly improve with metronidazole therapy, surgical complications do arise and diagnoses are missed. This series of cases emphasizes the need for surgeons working in Southern California to familiarize themselves with the clinical features, complications and appropriate surgical treatment of amebiasis.