Amebic liver abscesses (ALA) pose diagnostic and therapeutic challenges. We present the case of a 44-year-old Peruvian male with uncontrolled diabetes, who presented with insidious epigastric pain and fever. Abdominal ultrasound and computed tomography (CT) scans revealed a hepatic abscess compatible with Entamoeba histolytica, and calculous cholecystitis. After unsuccessful antimicrobial therapy, laparoscopic drainage followed by cholecystectomy enhanced by multimodal intraoperative imaging and drain placement were performed. Complete resolution was achieved. Definitive successful management of an ALA required antimicrobial therapy, escalation to laparoscopic drainage with multimodal intraoperative imaging, individualized stepwise drain management and endocrinological control. Timely-accurate diagnosis of ALA with atypical presentations and high-risk patients from endemic regions requires a high index of suspicion and imaging. Multidisciplinary-dynamic treatment is crucial for successful management of ALA.
Machuca et al. (Wed,) studied this question.