Liver abscess part I: Amebic abscess analysis of 73 cases

Abstract

1. 1. A study of 73 cases of amebic liver abscess is presented. 2. 2. The average age was forty-four years. The ratio of males to females was 8 to 1. 3. 3. Fifty-nine and six-tenths per cent gave a history of an antecedent diarrhea; 17.4 per cent showed amebae in the abscess and 36.1 per cent showed amebae in the stool in those cases in which these examinations were performed. 4. 4. The principal symptoms and signs were pain and tenderness, being found in 79.4 per cent. Fever and enlargement of the liver were found in 69.8 and 65.7 per cent, respectively. A diagnosis of amebic hepatitis was made preoperatively in 68.4 per cent. Positive x-ray diagnoses were made in 87.7 per cent. 5. 5. The prognosis in amebic hepatitis depends largely upon the presence of secondary infection and the type of operation used. In a series of 4035 cases collected from the literature, and including the authors' own cases, in which open operation was used, 1908 (47.2 per cent) ended fatally. In a similar series of 459 treated conservatively there were 32 deaths, a mortality rate of 6.9 per cent. 6. 6. In the authors' series of 70 cases in which treatment was used, 10 succumbed, 14.2 per cent mortality. Forty-six were operated upon with 9 deaths, a mortality rate of 19.5 per cent. Of these 16 were operated upon, employing the transpleural approach, with 4 deaths, a mortality rate of 25 per cent. Fourteen were operated upon through a right rectus incision with a 21.4 per cent mortality rate. Seven had simple incision and drainage over a presenting mass with a 14.2 per cent mortality rate. Nine had retroperitoneal operations with an 11.1 per cent mortality. 7. 7. The lowest mortality rate (4.1 per cent) was obtained in 24 cases treated conservatively by aspiration and the use of amebicides. 8. 8. The treatment of amebic hepatic abscesses which are not secondarily infected consists of aspiration and the use of amebicides and open operation should be employed only in those cases in which there is infection with pyogenic microorganisms.