Oludapo O Afuwape and Ijeoma N Chibuzo
Introduction: Hepatic abscess as a manifestation of sickle cell disease is rare. To our knowledge there is no report of a large hepatic abscess in these patients, thus documentation of open abd percutaneous drainage techniques alone exist. This is the first report of the use of laparoscopic trocar in the drainage of a massive hepatic abscess in a sickle cell disease patient. Case presentation: A 25 year old Nigerian Yoruba male with sickle cell disease presented with upper abdominal pain, fever, massive hepatomegaly, neutrophilic leucocytosis and mildly deranged liver enzymes. Ultrasonographic findings were a large thin walled right hepatic lobar abscess, with an estimated volume of 1419 ml. It was nonresponsive to antibiotic therapy. It was evacuated under general anaesthesia via trocar drainage. A size 14Fr nasogastric tube was introduced through the trocar into the abscess cavity as a drain, with good recovery postoperatively. Discussion: Trocar drainage was chosen because of the abscess characteristics, the massive size of the liver which made access with pneumoperitoneum difficult, and the minimally invasive nature of the therapy.
Conclusion: Percutaneous laparoscopic trocar drainage is effective in drainage of liver abscesses. The additional benefits of this minimally invasive treatment in a sickle cell disease patient are reduced trauma, pain and morbidity. This report would benefit gastroenterologists and haematologists for purposes of referral options, and offer surgeons another option of therapy.