[Hepatic Amoebic Abscess: Clinical Aspects And Prognosis At CHU De Gabriel Touré De Bamako]

The main goal of this study was to analyze hepatic amoebiasis abscess at the service of gastroenterology of CHU Gabriel Touré, Bamako- Mali.

MATERIAL AND METHOD

It was longitudinal and prospective study from January 2013 to February 2014 and concerned patients having hepatic abscess diagnosed by echography and amoebic serology or chocolate pus finding.

RESULT

During the study the frequency of disease was 2.4% (24/970). The sex-ratio was 2 with a mean age of 36.8±10.9 years. Smoking was observed in 58.8% of cases. Abdominal pain, fever and hepatomegaly were found respectively in 87.5%, 83.3% and 79.3% of patients. The abscess was mainly located in right lobe. HIV serology was performed among 18 patients and was negative in all cases. The medical treatment by the metronidazol was systematically proposed and was associated to abscess tap in 42.2% of patients. A total recovery was observed in 23 patients and 1 patient was died by abscess rupture in the peritoneum.

CONCLUSION

An early management cans evord complication.

[Diagnosis and therapeutic aspects of the amoebic liver abscesses in the surgery at point "G" Hospital]

AIM

Our aim was to evaluate the diagnosis and therapeutic aspects of the amoebic liver abscesses in the surgery «A» department of the University hospital Point "G".

PATIENTS AND METHODS

Were included in this study, patients admitted to the surgery «A» department for amoebic liver abscess confirmed by a positive amoebic serology and the chocolate appearance of bacteria-free pus. Bacterial liver abscesses were not included into this study.

RESULTS

Over a 10-year period, 52 cases of patients diagnosed with amoebic liver abscess were collected in the department. There were 41 men and 11 women, with a sex ratio of 3.7. The mean age was 37.8 years old with extremes of 15 and 66 years. The most represented professions were farmers (36.5%) followed by salesmen (26.7%) and students (11.5%). The average outpatient visit delay time was 18.5 days with the extremes of 5 and 34 days. The most frequent clinical signs were pain in the right hypochondrium (86.5%), fever (78.8%) and hepatomegaly (61.5%). Abdominal ultrasound showed a single located abscess in 44 patients (84.6%) and these abscesses were localized in the right hepatic lobe in 34 patients(65.4%). The average volume of the abscess was 366.5 cm³ with the extremes of 36 cm³ and 1580 cm³. Amoebic serology was positive in 38 patients (80.9%). Cytobacteriological analysis of pus in 37 patients (71%) was negative. Patients underwent an ultrasound assisted needle aspiration of pus in 65.4% he. Laparotomy and a laparoscopic approach were performed in 7.7% and in 5.8%, respectively. The clinical course was uneventfulin 94.2%. The mean hospital stay duration was 16.5 days with the extremes of 4 and 29 days. No death was recorded during hospitalization.

CONCLUSION

Amoebic liver abscess is an uncommon pathology in a surgical setting. Abdominal ultrasound andechography guided liver puncture allowed the diagnosis. Laparoscopic approach minimizes the burden of the laparotomy.

[Amoebic liver abscess in general surgery at the Gabriel Touré teaching hospital, Bamako, Mali]

The objectives were to determine the frequency, and to describe the clinical and therapeutic aspects of amoebic liver abscess. This was a retrospective study in the general surgery department of the Gabriel Touré teaching hospital from 1 January 2004 to December 2008. Included in this study, were all patients hospitalized and treated for amoebic liver abscess. We collected 53 cases a frequency of 1.3%. This was 45 men (84.9%) and 8 women (15.1%). The sex ratio was 5.6. The average age was 39.5 years. The average consultation time was 3 weeks. The signs observed were fever 96.2% (51 cases), the hepatalgia 94.3% (50 case), hepatomegaly 90.6% (48 cases) and anorexia 88.7% (47 cases). Collections of objectified abscess in abdominal ultrasound were located in the right lobe in 79.2% (42 cases), unique in 92.5% (49 cases) and 100 mm in diameter on average. Pulmonary radiography found an elevation of the right diaphragmatic dome 66.7% (14 cases). Amoebic serology was performed in 60.4% of cases, was negative in 2 cases (6.2%). Medical treatment alone was effective in the majority of cases - 62.7% (32 cases), an ultrasound-guided paracentesis associated with medical treatment was required in 31.4% (16 cases). Surgical methods were very rarely recommended 5.9 % (3 cases). The average amount of pus was 637.6ml. Average duration of treatment was 11 days. We recorded three deaths, including one due to a sepsis on peritonitis from ruptured liver abscess and 2 cases due to HIV.

CONCLUSION

The amoebic liver abscess is uncommon in our service. Negative serology does not exclude the diagnosis. Medical treatment is usually curative in the absence of complications.