Amebic liver abscess: An update

Figure 5 Proposed treatment algorithm for patient with amebic liver abscess. For uncomplicated amebic liver abscess (ALA): Upfront percutaneous drainage (PD) should be considered only in the presence of high risk signs; PD doesn’t provide added benefit when ALA size is < 5 cm, and ALA with size > 5 should be treated initially with medical therapy (MT) consisting of anti-amebic drug for 3-5 d before considering PD in case of non-response. For PD, a percutaneous catheter drainage (PCD) is preferred over needle aspiration, particularly for larger and incompletely liquified ALA. For complicated ALA patients, some form of drainage procedure is always required. A large majority of such patients can be treated with PCD along with MT. ALA with biliary fistula can be treated with prolonged PCD, and only on rare occasion, an endoscopic retrograde cholangiopancreatography will be required. Finally, ALA with rupture into a hollow viscus can be treated with MT alone. MT: Medical therapy; PD: Percutaneous drainage; ALA: Amebic liver abscess; PCD: Percutaneous catheter drainage; ERCP: Endoscopic retrograde cholangiopancreatography.