Accidental cannulation of amoebic liver abscess during pericardiocentesis: a case report

Abstract

Background Amoebiasis is a prevalent infection in the tropics and can sometimes present as liver abscess. Cardiac tamponade is an uncommon complication of ruptured amoebic liver abscess requiring urgent pericardiocentesis which has a high success rate but procedural complications can include injury to cardiac chambers, abdominal viscera and even death. This case underscores the approach to diagnose and manage an unintended visceral puncture during pericardiocentesis, which is a rare but life-threatening complication. Case summary A 41-year-old male presented with intermittent fever over two months and chest pain for fifteen days. Echocardiography revealed a significant pericardial effusion causing cardiac tamponade. In an emergency setting, percutaneous pericardiocentesis was attempted to drain the effusion. However, the pigtail inadvertently punctured a sizable liver abscess. Consequently, another pigtail was inserted into the pericardial cavity to successfully drain the effusion. Patient was discharged on day 12 and is doing well at 6 months follow up. Discussion An undetected case of ruptured amoebic liver abscess, who presented with the rare complication of cardiac tamponade requiring urgent pericardiocentesis which resulted in accidental cannulation of the liver abscess. This case underscores the significance of image guided pericardiocentesis in minimizing procedural complications. This case also highlights the intricacies of addressing accidental visceral puncture during pericardiocentesis, specially involving the liver. It also underscores the need to consider the possibility of a ruptured amoebic liver abscess when anchovy sauce like pus is drained from pericardial cavity, especially in high epidemiologically prevalent country like India.