Laparoscopy and transdiaphragmatic thoracoscopy in management of ruptured amebic liver abscess.

J Laparoendosc Adv Surg Tech A 18(3):473-6 (2008) PMID 18503388

In this paper, we present a case of an amebic liver abscess in a 30-month-old child, which presented to the senior author with a right empyema thoracic. Diagnosis was made with ultrasound of the abdomen and chest and a computed tomography scan. A surgical intervention was done after initial management, including when the chest-drain insertion failed. Laparoscopy was performed. With three working ports in the abdomen, the abscess was deroofed and the pus removed. A 3-cm defect in the diaphragm was identified. An intercostal drain site was utilized to use sponge holders and suction catheters to aid in the deroofing process. A laparoscope was then advanced through the defect and a thoracic toilet performed by using abdominal working ports and a chest-drain insertion site. According to us, this is the first case report of the laparoscopic management of a complicated amoebic liver abscess and the use of abdominal ports to treat empyema thoracic at the same sitting. The use of laparoscopy helped the child to recover faster, thereby avoiding major laparotomy and thoracotomy.