Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.916
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
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.