A case of amebic liver abscess complicated by hemobilia due to rupture of hepatic artery aneurysm
Yanagisawa, M.; Kaneko, M.; Aizawa, T.; Michimata, T.; Takagi, H.; Mori, M.
Hepato-Gastroenterology 49(44): 375-378
2002
ISSN/ISBN: 0172-6390 PMID: 11995454 Document Number: 545173
We report the case of a 51-year-old man from Japan with hepatic amoebic abscess complicated by hepatic artery aneurysm. The patient first presented with peritonitis caused by perforating appendicitis. Surgical treatment resolved peritonitis but Entamoeba histolytica was detected in the colonic mucosa. Subsequently, liver abscess developed and the size of the abscess increased gradually after surgery in spite of continued treatment with metronidazole. Brown pus was drained from the abscess but 13 days after the drainage process the patient complained of right upper abdominal pain and the drained fluid became blood-coloured and faeces became tarry in colour. Enhanced computed tomography showed a hepatic artery aneurysm that had ruptured into the liver abscess and duodenoscopy revealed bleeding from the ampulla of Vater. Transcatheter arterial embolization with several steel coils was successfully performed which resulted in cessation of bleeding from the ampulla of Vater. The patient was discharged without any complications five weeks after rupture of the aneurysm. Our case demonstrates rupture of the hepatic artery aneurysm as a rare complication of amoebic liver abscess and the effectiveness of interventional embolotherapy in this condition.