Successful surgical drainage with intraoperative ultrasonography for amebic liver abscess refractory to metronidazole an
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CASE REPORT
Open Access
Successful surgical drainage with intraoperative ultrasonography for amebic liver abscess refractory to metronidazole and percutaneous drainage: a case report Keita Kouzu1, Takahiro Einama1*, Makoto Nishikawa1, Makiko Fukumura1, Hiromi Nagata1, Toshimitsu Iwasaki1, Yoichi Miyata1, Yasuhiro Obuchi2, Kazuo Hase1, Hideki Ueno1, Yoji Kishi1 and Junji Yamamoto1,3
Abstract Background: Metronidazole (MNZ) has been clearly established as a medication for amebic liver abscess. In uncomplicated cases, surgical drainage should be avoided. We report a case of amebic liver abscess refractory to MNZ that was successfully treated using preoperative computed tomography (CT) and percutaneous and surgical drainage with intraoperative ultrasonography (IOUS). Case presentation: A 53-year-old man with high-grade fever was diagnosed with a cystic lesion on his right hepatic lobe using CT. Percutaneous drainage was performed, and antibacterial drugs were administered. However, the infection and condition of the patient worsened. Entamoeba histolytica was detected from pus within the mediastinal cavity. Hence, the patient was diagnosed with amebic liver abscess. After the diagnosis was established, we administered MNZ for 10 days. Despite this, the patient’s physical condition did not improve. Blood tests suggested impending disseminated intravascular coagulation (DIC). We performed surgical intervention to drain the amebic liver abscess refractory to conservative treatment. During surgery, imaging information from preoperative CT and IOUS enabled us to recognize the anatomical structures and determine the incision lines of the hepatic capsule and hepatic tissue. The patient’s DIC immediately regressed after surgery. Unfortunately, malnutrition and disuse syndrome contributed to the patient’s long recovery period. He was discharged 137 days post-surgery. Conclusions: We reported a case of amebic liver abscess refractory to conservative treatment. Surgical drainage with preoperative CT and IOUS allowed us to safely and effectively perform complex abscess decompression. Keywords: Amebic liver abscess, Surgical drainage, Intraoperative ultrasonography, Decompression, Entamoeba histolytica
Background Amebiasis is the parasitic disease of Entamoeba histolytica. It is the major cause of death from parasitic disease infection [1]. Amebic liver abscess is the most common * Correspondence: [email protected] 1 Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan Full list of author information is available at the end of the article
extraintestinal manifestation of amebic infection. Metronidazole (MNZ) is a clearly established, safe, and effective medication. Percutaneous drainage is usually not indicated, and surgical drainage should be avoided for uncomplicated amebic liver abscesses [2, 3]. We report a case of amebic liver abscess refractory to MNZ. We successfully treated the patient using percutaneous and
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