A CASE OF MULTIPLE AMOEBIC LIVER ABSCESS DIFFICULT TO DIAGNOSE PREOPERATIVELY

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A 51-year-old man was admitted for high fever and right hypochondralgia in confirmation of a diagnosis of cholecystolithiasis with acute cholecystitis. Antibiotics were was administered intravenous-ly, but the fever persisted. Because the multiple liver abscess revealed by computed tomography increased in size, we diagnosed it as acute progression of liver abscess. Ultrasound-guided percutaneous transhepatic abscess drainage (PTAD) was unsuccessful. Despite incubation of the pus and microscopic examination for amoeba, no bacteria were isolated and no amoeba could be found. Serological examina-tion was done, but Entamoeba histolytica was not detected. Additionally, the patient was not diagnosed to have HIV infection. Liver abscess increased rapidly and his general condition deteriorated. An emergency operation was performed. The final diagnosis was amoebic liver abscess based on discovery of trophozoites of the amoeba from pus. Rapid serological examination is necessary if intravenous injection of antibiotics proves unsuccessful. It was considered important to administer metronidazole as a preventive measure while keeping in mind a possible amoebic liver abscess.
日本臨床外科学会の論文