Sunil V Pawar, DM, Department of Gastroenterology, 7th floor OPD building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Dr. Anandrao Nair Road, Mumbai Central, Mumbai 400008, Maharashtra, India. svpnavodaya@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 25, 2015; 7(9): 916-919 Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.916
Unusual complication of amebic liver abscess: Hepatogastric fistula
Sunil V Pawar, Vinay G Zanwar, Pravir A Gambhire, Ashok R Mohite, Ajay S Choksey, Pravin M Rathi, Dileep S Asgaonkar
Sunil V Pawar, Vinay G Zanwar, Pravir A Gambhire, Ashok R Mohite, Ajay S Choksey, Pravin M Rathi, Department of Gastroenterology, 7th floor OPD building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, Maharashtra, India
Dileep S Asgaonkar, Department of Medicine, 1st floor College building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, Maharashtra, India
Author contributions: Pawar SV, Zanwar VG, Gambhire PA made substantial contributions to conception and design of the study, acquisition, analysis, drafting of article; Mohite AR, Choksey AS made critical revisions related to important intellectual content of the manuscript; final approval of the version of the article to be published was done by Rathi PM and Asgaonkar DS.
Informed consent statement: The study participant provided informed written consent.
Conflict-of-interest statement: There are no conflicts of interest of any authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sunil V Pawar, DM, Department of Gastroenterology, 7th floor OPD building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Dr. Anandrao Nair Road, Mumbai Central, Mumbai 400008, Maharashtra, India. svpnavodaya@gmail.com
Telephone: +91-22-23027206 Fax: +91-22-23021168
Received: November 21, 2014 Peer-review started: November 22, 2014 First decision: December 12, 2014 Revised: May 8, 2015 Accepted: May 27, 2015 Article in press: May 28, 2015 Published online: July 25, 2015 Processing time: 255 Days and 13 Hours
Abstract
Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.
Core tip: Hepatogastric fistula is a rare complication of the amebic liver abscess. High index of suspicion is required for its diagnosis. The presenting complaints may be brownish black vomitus or stool. It can be managed conservatively, endoscopically or surgically depending on case. Hence in cases of amebic liver abscess developing brownish black stools or vomiting we should always rule out hepatogastric fistula formation especially when it is associated with improvement of symptoms.
