The next day, the patient presented with dyspnea and auscultation revealed diminished breath sounds with diminished vocal resonance in the right hemithorax. The serologic examinations for HIV and hepatitis C were negative, as well as the Mantoux reaction. Biochemical and hematological profiling showed: SGOT: 71 U/liter, SGPT: 61 U/liter, LDH: 931 U/liter, CRP: 28.33 mg/dl, leucocytosis (12,900/μL) associated with polymorphonucleosis (88.2%), Ht 35% and Hb 11.8 g/dl. Radiological examination of the abdomen and chest revealed no pathologies. He was heterosexual with no history of intravenous drug use and worked as a bartender. Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.Ī 37-year-old white man, suffering from hepatitis B, presented to the emergency department with cough, low grade fever and night sweats. ConclusionĪcute abdomen due to a ruptured amebic liver abscess is extremely rare in western countries where the parasite is not endemic. The diagnosis of amebic abscess was made by the pathologists who identified E. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. Surgical drainage of the hepatic abscess was performed two wide drains were placed in the remaining hepatic cavities and one on the right hemithorax.
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A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII. Rapid deterioration of the patient's condition and acute abdomen led to an emergency operation. This report describes a 37-year-old white man, suffering from hepatitis B, with a gigantic amebic liver abscess presenting as an acute abdomen due to its rupture. Late diagnosis of the amebic abscess may lead to perforation and amebic peritonitis, resulting in high mortality rates. The large number of clinical presentations of amebic liver abscess makes the diagnosis very challenging in non-endemic countries. Liver abscess is the most common extra-intestinal manifestation. It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases. Amebiasis is a parasitic disease caused by Entamoeba histolytica.
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