Mukhopadhyay Madhumita, Saha Anil Kumar, Sarkar Amitava, Mukherjee Swadhin
Department of Surgery, Calcutta National Medical College and Hospital, Kolkata, West Bengal India.
Indian J Surg. 2010 Feb;72(1):37-41. doi: 10.1007/s12262-010-0007-6. Epub 2010 Feb 5.
Amoebic liver abscess (ALA) is the most common inflammatory space occupying lesion of the liver. It has a highly variable presentation causing diagnostic difficulties. Untreated, complicated ALA has high morbidity and mortality.
To study the various types of clinical presentation and complications of ALA in order to establish early diagnosis and prevent complications.
A prospective study was conducted in the Department of Surgery of Calcutta National Medical College and Hospital from July 2005 to June 2008. All patients with a confirmed diagnosis of ALA during this period were included in the study.
Seventy-two patients with 76 ALAs were studied over a 3-year period. The age ranged from 21 to 72 years (mean age being 43.64 years). There were 66 males (91.67% of the patients) and 6 females (8.33% of the patients). The (31-40 years) age group showed the highest incidence consisting of 40.28% of the cases. Pain was located most commonly in the right hypochondrium in 60 patients (83.33%). Fever was observed in 58 patients (80.56%). Solitary abscess cavity was present in 68 patients (94.44%). The right lobe alone accounted for 65 (85.53%) of the abscesses. The most common echo pattern encountered in ultrasonography was the echorich pattern in 54 (71.05%) abscesses. Forty-four patients (61.11%) gave history of alcohol consumption. Diagnosis was missed in 21 patients (29.17%), particularly in those with atypical presentations. The most common complication was pleuropulmonary in 24 patients (33.33%), followed by intraperitoneal rupture in 19 patients (26.39%). Other complications were jaundice (n = 11), ascites (n = 9), subhepatic effusion (n = 7), subphrenic abscess (n = 3) and intrapleural rupture (n = 2). Ultrasonography was useful in diagnosing ALA. Despite successful therapy 23 patients (31.94%) had residual abscess cavities on ultrasonography even after 6 months.
In an endemic area a patient presenting with lower chest or upper abdominal pain along with tender hepatomegaly should raise the suspicion of ALA. Sonography remains an important tool in the diagnosis of ALA.
阿米巴肝脓肿（ALA）是肝脏最常见的炎性占位性病变。其表现高度多变，导致诊断困难。未经治疗的复杂性ALA具有较高的发病率和死亡率。
研究ALA的各种临床表现和并发症，以建立早期诊断并预防并发症。
2005年7月至2008年6月在加尔各答国立医学院及医院外科进行了一项前瞻性研究。在此期间所有确诊为ALA的患者均纳入研究。
在3年期间对72例患者的76个ALA进行了研究。年龄范围为21至72岁（平均年龄43.64岁）。男性66例（占患者的91.67%），女性6例（占患者的8.33%）。（31 - 40岁）年龄组发病率最高，占病例的40.28%。60例患者（83.33%）疼痛最常位于右季肋部。58例患者（80.56%）出现发热。68例患者（94.44%）存在单个脓肿腔。仅右叶有65个脓肿（占85.53%）。超声检查中最常见的回声模式是54个脓肿（71.05%）的高回声模式。44例患者（61.11%）有饮酒史。21例患者（29.17%）漏诊，尤其是那些表现不典型的患者。最常见的并发症是24例患者（33.33%）出现胸膜肺部并发症，其次是19例患者（占26.39%）出现腹腔内破裂。其他并发症包括黄疸（n = 11）、腹水（n = 9）、肝下积液（n = 7）、膈下脓肿（n = 3）和胸腔内破裂（n = 2）。超声检查有助于诊断ALA。尽管治疗成功，但即使在6个月后仍有23例患者（31.94%）超声检查显示有残留脓肿腔。
在流行地区，出现下胸部或上腹部疼痛并伴有肝脏肿大压痛的患者应怀疑有ALA。超声检查仍然是诊断ALA的重要工具。
