An ununsual cause of liver abscess in western countries

Abstract

Background: Liver abscess for Ascaris lumbricoides is rare, accounting for 1% of all cases. It usually has a good response to conservative treatment with oral antihelmintics; however, the diagnosis in non-endemic areas can be very difficult. We present a case diagnosed following percutaneous drainage. Methods: A 60 year old male patient was admitted to our hospital with abdominal pain and high temperature. He previously underwent an endoscopic sphinterotomy for acute biliary pancreatitis. Liver ultrasound showed a 18 cm liver abscess. Results: The patient was submitted to percutaneous drainage, obtaining biliary content mixed with fragments dead ascarides. Diagnosis of Ascariasis was made and treatment with Albendazole was started with good outcome. Conclusion: Ascaris lumbricoides migrates through the biliary tree and it can occasionally be responsible for liver abscess even in non-endemic areas. This might have been facilitated by thr previous endoscopic sphyncterotomy.