Summary:We reviewed 204 cases of liver abscess seen between 1970 and 1985. Ninety were found to be amoebic, 24 pyogenic and one tuberculous. The cause of the abscesses in the remaining 89 patients was not established. The patients were predominantly male, Indians, and in the 30-60 age group. The majority of patients presented with fever and right hypochondrial pain. The most common laboratory findings were leucocytosis, hypoalbnminaemia and an elevated serum alkaline phosphatase. Amoebic abscesses were mainly solitary while pyogenic abscesses were mainly multiple. Complications were few in our patients and included rupture into the pleural and peritoneal cavities and septicaemic shock. An overall mortality of 2.9% was recorded.The difficulty in diagnosing the abscess type is highlighted. The single most important test in helping us diagnose amoebic abscess, presumably the most common type of abscess in the tropics, is the Entamoeba histolytica antibody assay. This test should be used more frequently in the tropics.

Sixteen patients with the congenital anomaly of pancreas divisum have been treated by enlarging the orifice of the accessory papilla. Attempts to do this at duodenoscopy succeeded in only 5 of 12 patients, and only one had a good clinical result. Sphincteroplasty was performed surgically in seven patients; five had a good or fair result. Most patients with poor results have undergone pancreatic resection. One patient died post-operatively; the remaining 15 divide equally as good (5), fair (5) and poor (5) results at follow-up after periods ranging from 7 months to 5 years. Results appear to be better in patients presenting with recurrent attacks of acute pancreatitis than in those with chronic pain. The preferred management for these patients remains unclear.

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