Background: A hepatic abscess is a benign disease caused by bacterial, fungal, or protozoan infection. The commonest cause of intrahepatic abscess is Entamoeba histolytica. Bacterial infections have been implicated in about 30% of cases. These organisms usually gain access into the liver via the portal, arterial, or lymphatic system. Diseased livers are usually at risk for abscess formation. Liver abscess rarely presents with jaundice.
Aim: The report intends to suggest that liver abscesses should be suspected in young persons with jaundice by clinicians.
Materials and Methods: The case report describes an unusual presentation of obstructive jaundice in a young woman with a huge liver abscess.
Case Report: A 32-year-old homemaker was presented to the surgical clinic with complaints of progressive abdominal swelling, intermittent epigastric pain for 2 years, and intermittent jaundice of a year duration, which was associated with passage of coca cola-colored urine, pale bulky stool, and severe pruritus. She had a positive hepatitis C serology diagnosed 2 years ago. On examination, a tachypnoeic and tachycardic young woman was seen with a basal metabolic index (BMI) of 20 kg/m2. Her abdomen was 36 weeks gestation in size with ascites. Radiological investigations revealed a huge intrahepatic cyst with hepatomegaly. Serum alkaline phosphatase was 3121 IU/L, markedly elevated, with high levels of conjugated bilirubin = 30 mmol/L and total bilirubin was 63 mmol/L. Hemoglobin concentration was 9 g/dL, clotting profile; prothrombin time (PT) was 13 s; and kaolin cephalin clotting time (KCCT) was 43 s. She had exploratory laparotomy with liver abscess drainage. The drainage was uneventful. Her jaundice, abdominal swelling, pruritus, and abdominal pain resolved, and coca cola-colored urine and pale stool color had resolved. Postoperatively, she received metronidazole, tinidazole, and chloroquine. She has remained well on follow-up.
Conclusion: Obstructive jaundice in well-preserved young people necessitates a high index of suspicion for huge intrahepatic abscesses.
Keywords: Hepatomegaly, jaundice, liver abscess