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Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess

Received: 3 May 2021     Accepted: 1 June 2021     Published: 9 June 2021
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Abstract

Background: Liver abscess if left untreated can rupture into adjoining pleura, pericardium, peritoneum. Rupture into pericardium, though very rare, is a dreaded complication and worsens the prognosis. Presentation here can be nonspecific. Rupture into pericardium if associated with cardiac tamponade often requires pericardiotomy. Case information: A 16-year boy presented with epigastric pain, fever and recent onset chest discomfort. No signs of cardiac tamponade were seen on clinical examination. Investigations revealed a left lobe liver abscess rupturing into pericardium and asymptomatic pericardial effusion. Serological testing confirmed the etiology to be amebic. The condition was using pigtail catheter drainage in both the pericardial cavity and hepatic abscess. Discussion: Ruptured liver abscess occurs more commonly due to delay in diagnosis. It increases the severity of disease depending upon the site of rupture. Pericardial rupture is the most feared complication out of these. Published literature lacks reports of asymptomatic pericardial rupture of liver abscess, and management options. Available literature reports invariable requirement of surgical drainage for this entity. This report shows that lesser invasive drainage procedures can successfully resolve this dreaded complication. Conclusion: Amoebic liver abscess rupturing into pericardium can be asymptomatic. Successful management with percutaneous drainage and double pigtail catheters offers resolution and avoids morbidity associated with surgical drainage.

Published in Journal of Surgery (Volume 9, Issue 4)
DOI 10.11648/j.js.20210904.11
Page(s) 149-152
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Amoebic Liver Abscess, Pericardial Rupture, Pigtail Catheter Drainage

References
[1] Albenmousa A. et al. Liver abscess presentation and management in Saudi Arabia and the United Kingdom. Ann Saudi Med. 2011 Sep Oct; 31 (5): 528-32.
[2] Wuerz T. et al. A review of amebic liver abscess for clinicians in a nonendemic setting. Can. J. Gastroenterol. 2012 Oct; 26 (10): 729-33.
[3] Gupta V. et al. Amoebic liver abscess ruptured into pericardium. Indian Heart J 1980; 32: 113-7.
[4] Suryanarayan K. et al. Amoebic pericarditis. Report of2 case Indian Heart J 1974; 26: 241-5.
[5] Blazquez S. et al. Initiation of inflammation and cell death during liver abscess formation by Entamoeba histolytica depends on activity of the galactose/N-acetyl-D-galactosamine lectin. Int J Parasitol 2007; 37: 425: 33.
[6] Stanley SL Jr. Amoebiasis. Lancet 2003, 361: 1025-34.
[7] Rao S. et al. Hepatic amoebiasis: A reminder of the complications. Curr Opin Pediatr 2009; 21: 145-9.
[8] Ibarra-Perez C. Thoracic complications of amebic abscess of the liver: Report of 501 cases. Chest 1981; 79: 672-7.
[9] Meng XY, Wu JX. Perforated amebic liver abscess: Clinical analysis of 110 cases. South Med 1994; 87: 985-90.
[10] Ibarra-Pérez C. et al. Rupture of amebic liver abscess into the pericardial cavity. Report of 11 cases. Prensa Med Mex 1972; 37: 242-5.
[11] Francis, Cliojis, et al. "A case report of ruptured amoebic liver abscess causing cardiac tamponade and requiring pericardial window." European Heart Journal: Case Reports 4.5 (2020): 1.
[12] Prateepchaiboon, Tanaporn, et al. "A rare case of massive pericardial effusion due to spontaneous rupture of Streptococcus anginosus group liver abscess." Clinical Journal of Gastroenterology 13.6 (2020): 1258-1264.
[13] Chandran, Suresh R., et al. "Amebic hepatopericardial fistula causing cardiac tamponade." Annals of Tropical Medicine and Public Health 5.4 (2012): 387.
[14] Jindal, Ankur, et al. "Management Practices and Predictors of Outcome of Liver Abscess in Adults: A Series of 1630 Patients from a Liver Unit." Journal of Clinical and Experimental Hepatology11.3 (2021): 312-320.
[15] Chong, V H et al. “Rare complications of pyogenic liver abscess.” Singapore medical journal vol. 51, 10 (2010): e169-72.
[16] Fauci, Anthony S. Harrison's principles of internal medicine. McGraw-Hill Education, 2015.
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  • APA Style

    Gautam Shubhankar, Ashutosh Nagpal, Gautam Anand, Deborshi Sharma. (2021). Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess. Journal of Surgery, 9(4), 149-152. https://doi.org/10.11648/j.js.20210904.11

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    ACS Style

    Gautam Shubhankar; Ashutosh Nagpal; Gautam Anand; Deborshi Sharma. Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess. J. Surg. 2021, 9(4), 149-152. doi: 10.11648/j.js.20210904.11

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    AMA Style

    Gautam Shubhankar, Ashutosh Nagpal, Gautam Anand, Deborshi Sharma. Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess. J Surg. 2021;9(4):149-152. doi: 10.11648/j.js.20210904.11

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  • @article{10.11648/j.js.20210904.11,
      author = {Gautam Shubhankar and Ashutosh Nagpal and Gautam Anand and Deborshi Sharma},
      title = {Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess},
      journal = {Journal of Surgery},
      volume = {9},
      number = {4},
      pages = {149-152},
      doi = {10.11648/j.js.20210904.11},
      url = {https://doi.org/10.11648/j.js.20210904.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.11},
      abstract = {Background: Liver abscess if left untreated can rupture into adjoining pleura, pericardium, peritoneum. Rupture into pericardium, though very rare, is a dreaded complication and worsens the prognosis. Presentation here can be nonspecific. Rupture into pericardium if associated with cardiac tamponade often requires pericardiotomy. Case information: A 16-year boy presented with epigastric pain, fever and recent onset chest discomfort. No signs of cardiac tamponade were seen on clinical examination. Investigations revealed a left lobe liver abscess rupturing into pericardium and asymptomatic pericardial effusion. Serological testing confirmed the etiology to be amebic. The condition was using pigtail catheter drainage in both the pericardial cavity and hepatic abscess. Discussion: Ruptured liver abscess occurs more commonly due to delay in diagnosis. It increases the severity of disease depending upon the site of rupture. Pericardial rupture is the most feared complication out of these. Published literature lacks reports of asymptomatic pericardial rupture of liver abscess, and management options. Available literature reports invariable requirement of surgical drainage for this entity. This report shows that lesser invasive drainage procedures can successfully resolve this dreaded complication. Conclusion: Amoebic liver abscess rupturing into pericardium can be asymptomatic. Successful management with percutaneous drainage and double pigtail catheters offers resolution and avoids morbidity associated with surgical drainage.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess
    AU  - Gautam Shubhankar
    AU  - Ashutosh Nagpal
    AU  - Gautam Anand
    AU  - Deborshi Sharma
    Y1  - 2021/06/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.js.20210904.11
    DO  - 10.11648/j.js.20210904.11
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 149
    EP  - 152
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20210904.11
    AB  - Background: Liver abscess if left untreated can rupture into adjoining pleura, pericardium, peritoneum. Rupture into pericardium, though very rare, is a dreaded complication and worsens the prognosis. Presentation here can be nonspecific. Rupture into pericardium if associated with cardiac tamponade often requires pericardiotomy. Case information: A 16-year boy presented with epigastric pain, fever and recent onset chest discomfort. No signs of cardiac tamponade were seen on clinical examination. Investigations revealed a left lobe liver abscess rupturing into pericardium and asymptomatic pericardial effusion. Serological testing confirmed the etiology to be amebic. The condition was using pigtail catheter drainage in both the pericardial cavity and hepatic abscess. Discussion: Ruptured liver abscess occurs more commonly due to delay in diagnosis. It increases the severity of disease depending upon the site of rupture. Pericardial rupture is the most feared complication out of these. Published literature lacks reports of asymptomatic pericardial rupture of liver abscess, and management options. Available literature reports invariable requirement of surgical drainage for this entity. This report shows that lesser invasive drainage procedures can successfully resolve this dreaded complication. Conclusion: Amoebic liver abscess rupturing into pericardium can be asymptomatic. Successful management with percutaneous drainage and double pigtail catheters offers resolution and avoids morbidity associated with surgical drainage.
    VL  - 9
    IS  - 4
    ER  - 

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Author Information
  • Department of General Surgery, Lady Hardinge Medical College, New Delhi, India

  • Department of General Surgery, Lady Hardinge Medical College, New Delhi, India

  • Department of General Surgery, Lady Hardinge Medical College, New Delhi, India

  • Department of General Surgery, Lady Hardinge Medical College, New Delhi, India

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