Audit of patients with ruptured amoebic liver abscess and outcome of surgical versus non-surgical treatment


  • Shrikant Perka Department of Plastic Surgery, Government Medical College, Nagpur, Maharashtra, India
  • Monty Khajanchi Seth GS medical college and KEM Hospital, Mumbai, Maharashtra, India
  • Amit Pothare Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India
  • Vipul Nandu Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India



Entamoeba histolytica, Amoebic liver abscess, Pig-tail catheter drainage, Ruptured amoebic abscess


Background: Amoebic liver abscess (ALA) is a common infection caused by parasite Entamoeba histolytica and is one of the leading causes of death in tropics. 10% of world population is infected with E. histolytica. It is highly endemic in India. This is a retrospective observational study conducted from July 2011 to November 2013. Aims and objectives are to study (1) Demographic, clinical features, treatment given and outcomes. (2) Compare outcome between surgical versus non-surgical methods (3) Assessing the complications of ruptured amoebic liver abscess.

Methods: Retrospective observational study of patients with ruptured amoebic liver abscess presenting to our institute (a tertiary referral centre). Details of demographics, clinical features, imaging findings were recorded. Also details of procedure, complications and outcome of surgical or non-surgical methods were recorded. Univariate analysis will be done applying ‘t’ test. Data will be analyzed using SPSS software.

Results: Pain in abdomen and tenderness was the most common presentation of patients (100% cases). Right lobe of liver was involved in 83.3% cases. Pigtail catheter drainage was the most common treatment modality given to patients (63.3% cases). Following rupture, pleural effusion was the most common complication noted in our study. Common sites for perforation include pleural cavity or bronchial tree (72%). The mean duration of stay in ward was 9.8 days. Zero percent mortality in patients who received non-surgical treatment compared to 40% mortality in patients treated surgically (2 out of 5).

Conclusions: This study concluded that there is significant mortality in patients of ruptured amoebic liver abscess all associated with surgical intervention compared to non-surgical measures. Surgery is reserved for cases of generalized peritonitis or of superadded infections not responding to non-surgical measures with guarded prognosis.


Kimura K, Stoopen M, Reeder MM, Moncada R. Amebiasis: modern diagnostic imaging with pathological and clinical correlation. Semin. Roentgenol. 1997;32(4):250-75.

Li E, Stanley SL. Protozoa Amebiasis. Gastroenterol Clin North Am. 2013;25(3):471-92.

DeCock KM, Reynolds TN, Ralls PW. A comparison of amoebic and pyogenic abscess of the liver. Medicine. 1987;66:472-82.

Yeoh KG, Yap I, Wong ST, Wee A, Guan R, Kang JY. Tropical liver abscess. Postgrad Med J. 1997;73(856):89-92.

Sarda AK, Bal S, Sharma AK, Kapur MM. Intraperitoneal rupture of amoebic liver abscess. Br J Surg. 1989;76(2):202-3.

Mukhopadhyay M, Saha AK, Sarkar A, Mukherjee S. Amoebic liver abscess: presentation and complications. Indian J Surg. 2010;72(1):37-41.

Ralls PW, Barnes PF, Johnson MB, Cock KM De, Radin DR, Halls J. Medical treatment of hepatic amebic abscess: rare need for percutaneous drainage. American Public Health Association; 2013 Available at: Accessed 11 January, 2014.

Sharma N, Sharma A, Varma S, Lal A, Singh V. Amoebic liver abscess in the medical emergency of a North Indian hospital. BMC Res Notes. 2010;3:21.

Adeyemo AO, Aderounmu A. Intrathoracic complications of amoebic liver abscess. J R Soc Med. 1984;77(1):17-21.

Lyche KD, Jensen WA, Kirsch CM, Yenokida GG, Maltz GS, Knauer CM. Pleuropulmonary manifestations of hepatic amebiasis. West J Med. 1990;153(3):275-8.

Ramani A, Ramani R, Kumar MS, Lakhkar BN, Kundaje GN. Ultrasound-guided needle aspiration of amoebic liver abscess. Postgrad Med J. 1993;69(811):381-3.

Weinke T, Grobusch MP, Güthoff W. Amebic liver abscess-rare need for percutaneous treatment modalities. Eur J Med Res. 2002;7(1):25-9.

Saraswat VA, Agarwal DK, Baijal SS, Roy S, Choudhuri G, Dhiman RK, et al. Percutaneous catheter drainage of amoebic liver abscess. Clin Radiol. 1992;45(3):187-9.

Ibarra-Pérez C. Thoracic complications of amebic abscess of the liver: report of 501 cases. Chest. 1981;79(6):672-7.






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