Authors

V Silvestri¹; J Nyanda¹; W Bonavenuture¹; M I Mshana¹; G Ogweno¹; B Ngasala¹;  ¹ Department of Parasitology and Medical Entomology, Muhimbili University of Health and Applied Science MUHAS P.O. Box 65001 Dar es Salaam Tanzania, Tanzania

Discussion

Introduction Entamoeba histolytica is a protozoan parasite with worldwide distribution, higher in countries with poor sanitation due to its oral-faecal way of transmission. It is the causative agent of amoebic colitis extraintestinal amoebiasis, and accounts for 40 000–100 000 death yearly (1). Amoebiasis can be complicated by amoebic liver abscess in 9% of all cases (2). Rarely, also vascular complications have been reported (portal, hepatic and vena cava thrombosis). (3). Aneurysm of the hepatic artery have been reported in rare case reports in patients with amoebic hepatic abscess (3). Aim and methods Aim of our study was to describe clinical presentation, details of vascular lesions, treatment and outcome of patients with a history of amebiasis complicated by hepatic abscess presenting with aneurysm of hepatic vessels (key words “Amoebiasis AND aneurysm). Results Six case report were included. Mean age of patients was of 44.8±8 years, ranging from 31 to 52. All patients were male. Leucocytosis, anaemia, fever, abdominal pain hematemesis, haemobilia, melena and hepatomegaly were the most frequently reported signs and symptoms. Aneurysms lesions occurred in hepatic artery (3 cases, 50%) or in its branches. In 2 cases rupture occurred (in abscess and subphrenic region). In three cases aneurysm embolization has been successful in treating arterial lesion. Spontaneous regression after liver abscess drainage occurred in 2 cases. Uneventful recovery was reported in five patients with follow up data. Discussion Hepatic artery aneurysm are the second most common type of visceral artery aneurysm reported. Its natural history and incidence are unknown. The latter has been estimated from small case series and autopsy to be 0.002%. Association with fibromuscular dysplasia, vasculitis, genetic causes and untreated bacterial endocarditis have been reported (4). Aneurysm lesions of the hepatic circulation can occur in patients with amoebic hepatic abscess. It can be complicated by rupture in biliary ducts and haemobilia. A conservative management with hepatic abscess drainage or interventional aneurysm embolization, according to size, location of aneurysm, clinical status of the patient, and response to antibiotic therapy have been reported to be successful in treatment of this vascular condition in this specific setting (5).Conclusions Hepatic artery aneurysms may complicate amebiasis in patients with hepatic abscess. Even though the disease has a high burden, specifically in developing countries, only data from sporadic case report are available, suggesting underreporting bias. Further studies are needed to better understand this non-communicable vascular complication of a disease of parasitological interest.