7 [Hepatogastric Fistula ; a rare complication of liver abscess in a 2 year old]
Hamza Sohail, Shabbir Hussain
Liaquat National Hospital, Karachi, Pakistan

Abstract

CASE REPORT
A 2 year old female child had presented with history of fever and upper abdominal pain for 2 weeks. She was diagnosed as having left lobe liver abscess measuring 5 * 4 cm that had ruptured into the lesser sac. Initially abscess cavity was drained by ultrasound guided pigtail insertion ; however fever didn’t resolve even after drainage and there was persistent drain output of between 50-100 ml/24hrs. So CT scan abdomen with oral and IV contrast that showed hepatogastric fistula with pigtail lying in the stomach. So Laparotomy was done that revealed stomach perforation that was repaired primarily. Child improved postoperatively, started oral on 5th postoperative day and discharged on 8th postoperative day with no complications. She has been followed for 6 months with good weight gain and no post-surgical issues.

DISCUSSION
Fifteen cases of ALA rupturing into stomach have been reported and only three being in children. The diagnostic clues included vomiting or ryle tube aspirate showing typical anchovy sauce pus or passage of amebic pus per rectum. One patient presented with air in the abscess cavity on plain X-ray of abdomen. Rarely a fistulous tract between the abscess cavity and the stomach is reported on upper GI contrast study
Surgical intervention has been recommended by many authors for complicated and ruptured ALA and amoebic abscess rupturing into the gastrointestinal tract was considered as surgical entity

CONCLUSION

Hepatogastric Fistula is a very rare but impoertant complication of amebic liver abscess, which when suspected, should be early recognised and managed either medically or surgically in most cases to prevent morbidity


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