The Clinical Syndrome of Amebic Abscess of the Left Lobe of the Liver

Abstract

An attempt is made to define the clinical syndrome of amebic abscess of the left lobe. Anatomical differences between the two liver lobes seem to be essentially responsible for the distinctly different clinical appearance with right and left lobe abscesses. An enlarged liver, particularly a left lobe, and a febrile patient with severe pain in the epigastrium and left hypochondrium, or in both, are characteristic findings. On X-ray examination changes in stomach contour and position, and pressure on the colon are characteristic and usually permit a specific diagnosis. Left lobe abscesses have a particular tendency to perforate. Extension into the peri-cardial sac has also been seen. Jaundice appears to be comparatively frequent when perforation into a lesser sac has occurred. Icterus is obstructive and offers an explanation of its possible mechanism. In spite of the fact that patients may sometimes respond to conservative management, we are of the opinion that the diagnosis of an amebic abscess of the left liver lobe constitutes an almost absolute indication for additional surgical intervention. Reasons for the comparative rarity of left lobe abscesses are discussed. Proper evaluation of these factors might contribute to the understanding of the pathogenesis of left lobe abscesses as distinct from those of the right lobe.