Amoebic liver abscess draining into the bile ducts.

CASE 1 A 19-year-old Bantu man was admitted to Miguel Bombarda Hospital on 3 December 1963. Mild, vague, upper abdominal pain had commenced one month earlier and was associated with chills and fever, generalized malaise, weakness and weight loss. Two weeks later a slight bulge appeared in the right upper quadrant. His symptoms increased in severity and jaundice appeared; there was no nausea or vomiting and his stools were normal. On examination he was thin, jaundiced and ill. The temperature on admission was 38 8°C. and blood pressure 110/70 mm. Hg. There was a visible swelling in the right upper quadrant of the abdomen with slight oedema of the overlying skin. The liver was enlarged 9 cm. below the right costal margin. Examination of the chest showed the right diaphragm to be elevated. There was a previous history of schistosomiasis and chronic alcoholism. Investigations Haemoglobin was 12-2 g./100 ml.; white cell count was 8,550 (neutrophils 74%, lymphocytes 23%, eosinophils 2%, myelocytes 1 %); the erythrocyte sedimentation rate was 105 in one hour (Wintrobe). Alkaline phosphatase level was 4 Bodansky units; serum total bilirubin 3-9 mg./100 ml.; conjugated bilirubin 1-6 mg./100 ml. Prothrombin index was 48% of normal. Bromsulphalein test gave 18% retention at 45 minutes. Glutamic oxaloacetic transaminase level was 120 Karman units (normal 20 to 25) and glutamic pyruvic transaminase 83 Karman units (normal 20 to 25). Sigmoidoscopy showed no abnormality. In the urine were ova of Schistosoma haematobium and in the faeces