Amoebic liver abscess: an unusual cause for a right iliac fossa mass: a case report

A case of amoebic liver abscess and emphysematous gallbladder in a 65-year-old male with situs inversus totalis

INTRODUCTION AND IMPORTANCE

Situs inversus totalis, a rare congenital condition, is characterized by the mirror-image reversal of the abdominal and thoracic organs. Amoebic liver abscess and emphysematous gallbladder are severe gastrointestinal infections. The coexistence of these three conditions is extremely rare.

CASE PRESENTATION

We present the case of a 65-year-old male who presented with abdominal pain, fever, and jaundice. Investigations revealed situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder. The patient underwent successful treatment with antibiotics and open surgery drainage of the liver abscess, and subtotal cholecystectomy.

CLINICAL DISCUSSION

The co-occurrence of situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder poses a diagnostic challenge and requires thorough evaluation and appropriate management.

CONCLUSION

Situs inversus totalis may coincide with other conditions like amebic abscess and emphysematous gallbladder, complicating diagnosis and treatment. Early diagnosis and prompt intervention are crucial to improve outcomes.

Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem

Entamoeba histolytica (E. histolytica) is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. E. histolytica is endemic to sub-tropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of E. histolytica have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the Entamoeba species. As a preventable illness, E. histolytica complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of E. histolytica-induced ALA, to help address this endemic problem on the island of SLK.