Niger J Paed 2015; 42 (1): 71 –72

CASE REPORT

Ejike O

Amoebic liver abscess: Drained

Eleweke N

by ultrasound guided

percutaneous aspiration

DOI:http://dx.doi.org/10.4314/njp.v42i1,16

Accepted: 27th August 2014

Abstract

Summary:

Amoebic

sound guided percutaneous needle

Liver Abscess in a 20-month-old

aspirations over a period of 4

Ejike O

(

)

child: A case of amoebic liver

weeks with subsequent resolution

Department of Paediatrics

abscess in a Nigerian child is pre-

and recovery. This high lights

Eleweke N

sented. Management consisted of

another method of dealing with

Department of Surgery

10days course of Metronidazole

difficult cases of amoebic liver

Abia State University Teaching

and 5days course of Tinidazole

abscess that may be employed

Hospital, Aba Nigeria.

without improvement. This was

when necessary.

Email: obuoha@yahoo.com

followed by four sessions of ultra-

Introduction

Case report

Amoebiasis is a parasitic infection of the lumen of the

A 20-monthold child was admitted into the Paediatrics

gastrointestinal tract caused by Entamoebahistolytica. It

ward of Abia State University Teaching Hospital, Aba,

is probably the most widely distributed of the protozoal

in February 2003 on account of fever, frequent mucoid

diseases . The clinical manifestations are varied and

1

stools and cough of two weeks duration. He had at-

influenced by the nutritional status of the patient . As-

2

tended other private clinics in town and had received

ymptomatic infection is common in many infected sub-

oral rehydration solutions, antimalaria drugs; Amoxicil-

jects. However symptoms may include fever, colicky

lin and Metronidazole but symptoms had persisted. On

abdominal pain, and diarrhoea with tenesmus and occa-

examination he was ill-looking and irritable, temperature

of 38.2 C and was moderately dehydrated. He weighed

o

sional bloody stools. In a small proportion of infected

subjects the organism invade the intestinal mucosa and

10.0kg. There was a palpable soft to firm, acutely tender

cause severe symptoms such as high grade fever, fea-

mass over the right lobe of the liver measuring 8 by

tures of acute abdomen, bloody diarrhoea and dehydra-

10cm. The liver and spleen were 8cm and 3cm enlarged

tion or may disseminate to distant organs especially the

below the costal margins respectively. The chest was

liver and lungs

1,2,3

. Many amoebas invade the portal

clinically clear. Malaria parasite test was negative, hae-

moglobin level was 9.5gm/dl. Total WBC was 6.3 x10 /

3

vein, but it is the liver with reduced resistance from mal-

nutrition, toxic agents and alcoholism that is commonly

uLwith adifferential of neutrophil 60%, lympho-

cyte38%, monocytes 2%, ESR was 23mm/1 hr wester-

st

affected. Other extra-intestinal sites include pleura, peri-

cardium and rarely the brain. Chronic infection may lead

gren. Liver Function tests were within normal limits as

to granulomatous lesions called amoeboma

1, 2, 3

. Preva-

were urinalysis and urine microscopy. Stool microscopy

lence of amoebic infections is worldwide, varies from 5

show cysts of Entamoebahistolytica. The Liver ultra-

- 81%. Prevalence increases with poor personal hygiene,

sound shows a large solitary cyst in the right lobe of the

low socio-economic and sanitary standards. Intestinal

liver measuring 10 to 12cm (Figure 1). The patient re-

mucosal invasion is found in approximately 1-17% of

ceived intravenous Ampiclox, oral Tinidazole and Oral

infected subjects. Extra intestinal disseminations to in-

rehydration solution. Over the following 10 days the

ternal organs such as the liver occur in an even smaller

fever persisted and the hepatic mass became progres-

fraction of infected individuals <1% and much less com-

sively bigger and tender (Figure 1, before aspiration).

mon in children than adults . Liver abscess may occur in

4

After failed amoebicidal treatment with drugs, ultra-

people who have not been to endemic areas . There are

5

sound guided percutaneous aspiration with a 14G can-

few reports of amoebic liver abscess in children and this

nula at four different sessions over a period of four

is the first ever from Abia State University Teaching

weeks successfully evacuated the liver abscess (Figure ,

Hospital Aba, reporting successful ultrasound guided

after aspiration) with complete recovery of the child. At

percutaneous drainage of amoebic liver abscess. This

the first session 160 ml of chocolate-coloured fluid was

case was unresponsive to commonly used tissue amoebi-

aspirated and the cavity injected with 0.9% saline solu-

cides.

tion. Microscopic examination of the aspirate did not

reveal cyst of Entamoebahistolytica nor did culture yield

bacterial growth.

72

and shorten hospital stay

6,7,8,9

. It may be accomplished

Pre-Aspiration

percutaneously by a large bore needle, a pigtail catheter,

and sump catheter or by peritoneoscopic or laproscopic

routes . Repeated sessions of aspiration may risk haem-

7

orrhage or secondary infection

8,9,10

. None of these were

encountered in this case. Demonstration of E. histolytica

in stool remains the only incontrovertible proof of intes-

tinal amoebiasis, the examination takes time and is often

difficult. In addition, prior treatment with agents like

Tetracycllin and Sulfonamides causes amoebas to disap-

pear from stool. In the contrary, stool from most patients

Post Aspiration

with amoebic liver abscess are negative for amoebas in

50% of cases. Serological test as indirect hemagglutina-

tion, indirect immunoflurescence, countercurrentimmu-

noelectrophoresis and agar gel diffusion and ELISA are

all most useful for diagnosis of extra intestinal amoebi-

asis (92-98% positive)

2,4,10,11

. None of these methods

were applied in this case.

Conclusion

Discussion

A case of amoebic liver abscess that failed to respond to

Hepatic amoebiasis is a disease of the tropics and sub-

commonly used tissue amoebicidesis presented and usu-

tropics . Extra-intestinal dissemination is uncommon in

1

ally becomes complicated if prompt actions such as as-

children but when it occurs they tend to have a rapidly

piration or drainage are not instituted. This case illus-

progressive course/illness with complications and high

trates successful treatment through ultrasound guide

mortality rates . Amoebic liver abscess may rupture into

3

percutaneous needle aspirations. Employment of this

the peritoneum or thorax, or through the skin when diag-

technic should not be delayed, it is life saving as well as

nosis and effective treatment are delayed. Extra intesti-

reducing hospital costs.

nal disease in children when it occurs is responsive to

amoebicidal treatment but resistant cases have been en-

Conflict of interest: None

countered .

4

Funding: None

Percutaneous drainage of liver abscess is a useful ad-

junct to drug therapy and is known to hasten recovery

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