Amebic liver abscess: clinical presentation and diagnostic difficulties

ABSTRACT

To identify the symptoms and signs of amebic liver abscess [ALA] in our population in order to establish early diagnosis. Subjects and A prospective study was conducted in the Department of Surgery, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan, during the year 2000 to 2002 [2 1/2 years]. All patients with a confirmed diagnosis of A L A during this period were included in the study. The detailed history and relevant clinical data including investigations and daily progress were recorded on proforma, later analyzed and compared with other studies. Fifty-three patients with ALA, accounting for 0.5% of yearly hospital admission were included in this study. The age ranged from 10 to 60 years [mean 29 years]. The male to female ratio was 2.8 to 1. Upper abdominal pain occurred in 90%, right upper abdominal quadrant pain in 70%, radiation to tip of right shoulder in 10%, fever in 85%, co-incident diarrhea in 7.5% and concurrent pulmonary symptoms in 26%. The most common signs were tender hepatomegaly in 79%, and jaundice in 20.7%. Abscess ruptured in 3.8% due to delayed diagnosis, and ruptured despite treatment in another 3.8%. Diagnosis was missed in 28% of the patients particularly those with atypical presentations. Ultrasonography [US] was useful in diagnosing ALA. A L A has a highly variable presentation. Clinical diagnosis is difficult. Delayed diagnosis may result in rupture of abscesses. High index of clinical suspicion combined with US of abdomen is helpful in reaching an early diagnosis