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Amoebic Liver Abscesses in Fiji: Epidemiology, Clinical Presentation and Comparison of Percutaneous Aspiration and Percutaneous Catheter Drainage

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Background

Amoebic liver abscess (ALA) is a common clinical problem in tropical countries related to poor sanitation. The epidemiology and clinical presentation of ALA in Fiji has not been previously described. It is unclear whether percutaneous aspiration (PA) or percutaneous catheter drainage (PCD) has better outcomes.

Purpose

The aims were to describe the epidemiology and clinical presentation of ALA in Fiji and to compare the outcomes of PA and PCD for treatment of ALA.

Methods

A retrospective case note review of patients treated with either PA or PCD between 2010 and 2015 was performed. Indications for intervention were ALA > 5 cm, ALA in the left lateral lobe, risk of imminent rupture and failure to respond to medical treatment.

Results

There were 262 patients, 90% were male, 92.9% I-Taukei ethnicity and 86.2% regular recreational kava drinkers. Most presented with upper abdominal pain and fevers. The majority (90.3%) had a single abscess with 87.8% being in the right lobe. 174 (66.4%) had LA and 88 (33.6%) had PCD. There was an unintended selection bias for PA in abscess with a volume of <1 litre. PA was associated with a more rapid resolution of fever and shorter hospital stay, more rapid resolution of the cavity and no morbidity. PCD had five complications, one bleed and four bile leaks. There was no mortality in either group.

Conclusions

ALA in Fiji occurs in I-Taukei males who drink kava. PA appears to offer equivalent if not better outcomes for treatment of ALA.

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Acknowledgements

We acknowledgeDr. Aneley Getahum (School of Public Health, Fiji National University) and Dr. Devina (Fiji Ministry of Health) for advice and oversight during the collection of data and Miss Sabha Khan (School of Public Health, Fiji National University) and Professor Guy Eslick (Whitely-Martin Surgical Research Unit, University of Sydney, Nepean Hospital) for biostatistical advice and analysis of data.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji

    Esala Vakamacawai, Eddie McCaig, Ifereimi Waqainabete & Michael R. Cox

  2. Nepean Clinical School, Nepean Hospital, The University of Sydney, Clinical Sciences Building, P. O. Box 67, Penrith, NSW, 2751, Australia

    Michael R. Cox

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  1. Esala Vakamacawai
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Vakamacawai, E., McCaig, E., Waqainabete, I. et al. Amoebic Liver Abscesses in Fiji: Epidemiology, Clinical Presentation and Comparison of Percutaneous Aspiration and Percutaneous Catheter Drainage. World J Surg 44, 665–672 (2020). https://doi.org/10.1007/s00268-019-05274-7

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