Amoebic liver abscess: Rupture into retroperitoneum

Abstract

The first documented case of amoebic liver abscess which ruptured into the retroperitoneum is reported.Abscess -Amoebic -Rupture.Hepatic amoebiasis is a common extra-intestinal manifestation of infection with Entamoeba histolytiea. The clinical course is often punctuated by complications arising from either direct rupture and spread of the abscess (e.g., subphrenic rupture, empyema, peritonitis, pericarditis, splenic and renal spread) or by metastatic involvement to distant sites (e.g., lung and brain abscesses). We present an extremely rare complication of an amoebic liver abscess, which spread and gave rise to a retroperitoneal collection. Case ReportA 40-year-old man with a history of excessive regular alcohol intake for the last 10 years, presented with a 3-month history of episodic fever, weakness, and malaise. He also developed pain in the left lower quadrant of the abdomen, which began a few days prior to admission. Besides the fever, he had no other localizing features on history. Examination revealed a right-sided pleural effusion, and a 3-cm mildly tender hepatomegaly. There was no icterus or any stigmata of chronic liver disease, portal hypertension, or hepatic venous outflow tract obstruction.Complete blood count, liver function tests, renal function tests, stool and urine examinations were normal except for moderate anemia with hemoglobin of 8.9 g %, with normocytic normochromic red cells, About 500 ml of straw-colored pleural fluid was drained. This was an exudate with a protein count of 4 g % and a predominantly lymphocytic differential count. Bacterial, mycobacterial, funsal, and amoebic cultures were sterile.Ultrasonography and computed tomography (CT) of the abdomen revealed a large abscess measuring 9 x 8 x 7 cm in the posterior part of the right lobe of the liver, and suggested that the abscess extended into the retroperitoneum through discontinuity into the posterior margin of liver (Fig. 1). Bilateral retroperitoneal fluid collection displaced the kidneys anteriorly and compressed the psoas muscles posteriorly. The retroperitoneal collections of both sides communicated with each other in front of L~ and L5 vertebrae and extended into the pelvis and left femoral triangle (Figs. 2 and 3).Fluid was drained from the liver and the retroperitoneal collection under ultrasound guidance was subjected to laboratory evaluation. Aspirate from both sites revealed similar fluid -gross appearance being chocolate brown in color and moderately thick in consistency.Analysis of the fluid showed a total cell count of 4400/mm 3 [2400 white cells (predominantly polymorphs), 2000 red cells].Smears showed no E. histolytica trophozoites, Gram staining revealed no bacteria, and the Ziehl-Neelsen stain revealed no acid-fast bacilli. Bacterial, anaerobic, amoebic, funsal, and mycobacterial cultures of the pus were sterile. Amoebic antigen was detected in the fluid from both hepatic and retroperitoneal collections. Amoebic serology (by indirect hemagglutination) was positive in a titre of I : 1458. Treatment and CourseT...

Amebic liver abscess rupturing into the lesser omentum space

“…The mass was located between the liver and the pancreas, as if the mass had originated in the pancreas and was protruding into the liver. Although imaging examinations revealed signs of liver abscess in other previously reported cases, the present case showed no evidence of a liver abscess (Figs. ).…”

“…There have been many cases of an amebic liver abscess rupturing into the abdominal cavity and causing generalized peritonitis . Rare cases have been reported of rupture into the pericardial cavity, the pleural cavity,, the biliary tract,, a hepatic aneurysm, the retroperitoneum, the stomach, and the greater omentum, but there have been no reports of rupture into the lesser omentum producing a localized abscess.…”

A case of hepatocolic fistula after percutaneous drainage for a gas-containing pyogenic liver abscess

“…2-4 Nevertheless, it is widely accepted that the clinical course of "amebic" liver abscess is often characterized by complications arising from rupture and penetrating extension to the adjacent organs. [5][6][7][8][9] When air is encountered on diagnostic images in a patient with suspected intrahepatic abscess, disorders such as gas-forming infection, hepatobronchial fistula, and hepatoenteric fistula should be considered. 9 In the present patient, however, a radiological study performed at an early stage after PTAD disclosed no fistulous connection to the adjacent organs or intrahepatic biliary tree.…”

“…[5][6][7][8][9] When air is encountered on diagnostic images in a patient with suspected intrahepatic abscess, disorders such as gas-forming infection, hepatobronchial fistula, and hepatoenteric fistula should be considered. 9 In the present patient, however, a radiological study performed at an early stage after PTAD disclosed no fistulous connection to the adjacent organs or intrahepatic biliary tree. Therefore, this fistula formation was thought to be closely related to the necrosis of the thin wall of the gas-forming liver abscess, which in the penetration by the abscess of the adhering adjacent colon, due to the long-term compression of the drainage tube.…”

Hepatic abscess rupture into the pyelocalyceal system of right kidney

“…Ruptue of amebic liver abscess into the retroperitoneum is uncommon. [ 1 ] We present images of a patient with a pyogenic liver abscess that ruptured into the pyelocalyceal system of the right kidney and was draining through the urinary tract.…”