Obstructive Jaundice: A Rare Presentation of Amoebic Liver Abscess

Abstract

Jaundice is a relatively uncommon finding in amoebic liver abscess and if present, is a marker of abscess erosion into biliary tract. In these cases, other causes of jaundice are secondary infection of amoebic liver abscess (ALA), pressure of the abscess on hepatic ducts, parenchymal damage or, sometimes could be cholestatic in nature. In our case, a twenty-five year-old male student presented with jaundice and fever. There was hepatomegaly and a mass of approximately 8x6 cm protruding into right hypochondrium and epigastrium. Jaundice occurred in this case due to compression of the hepatic ducts confluence by a large abscess, thus causing bi-lobar intrahepatic biliary dilatation (IHBRD). Patient was treated by ultrasound guided catheter drainage of liver abscess and metronidazole administation in view of positive amoebic serology. Patient showed clinical improvement, catheter was removed after four days and he was later discharged. On follow-up after two weeks, his bilirubin levels had returned to normal and a review ultrasound of abdomen showed no residual abscess. Prompt drainage of abscess upon diagnosis is important to relieve jaundice and prevent catastrophic complications such as peritonitis or empyema secondary to its rupture, pleural or pericardial effusion, splenic vein thrombosis and cholangitis.