Gigantic hepatic amebic abscess presenting as acute abdomen: a case report

<p>Abstract</p> <p>Introduction</p> <p>Amebiasis is a parasitic disease caused by <it>Entamoeba histolytica</it>. It most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients develop intestinal invasive or extra-intestinal diseases. Liver abscess is the most common extra-intestinal manifestation. The large number of clinical presentations of amebic liver abscess makes the diagnosis very challenging in non-endemic countries. Late diagnosis of the amebic abscess may lead to perforation and amebic peritonitis, resulting in high mortality rates.</p> <p>Case presentation</p> <p>This report describes a 37-year-old white man, suffering from hepatitis B, with a gigantic amebic liver abscess presenting as an acute abdomen due to its rupture. Rapid deterioration of the patient's condition and acute abdomen led to an emergency operation. A large volume of free fluid together with debris was found at the moment of entry into the peritoneal cavity because of a rupture of the hepatic abscess at the position of the segment VIII. Surgical drainage of the hepatic abscess was performed; two wide drains were placed in the remaining hepatic cavities and one on the right hemithorax. The patient was hospitalized in the ICU for 14 days and for another 14 days in our department. The diagnosis of amebic abscess was made by the pathologists who identified <it>E. histolytica </it>in the debris.</p> <p>Conclusion</p> <p>Acute abdomen due to a ruptured amebic liver abscess is extremely rare in western countries where the parasite is not endemic. Prompt diagnosis and treatment are fundamental to preserving the patient's life since the mortality rates remain extremely high when untreated, even nowadays.</p

Evaluation of bedside tests and proposal of a model for predicting difficult laryngoscopy: an observational prospective study [Avaliação de testes à beira leito e proposta de modelo para prever laringoscopia difícil: estudo prospectivo observacional]

Background and objectives: The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model. Methods: This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height‐to‐Thyromental Distance (R‐H/TMD), Neck Circumference (NC), Ratio of Neck Circumference‐to‐Thyromental Distance (R‐NC/TMD), Hyomental Distance with head in Neutral Position (HMD‐NP) and at Maximal Extension (HMD‐HE), Ratio of Hyomental Distance at Maximal head extension‐to‐hyomental distance in neutral position (R‐HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack‐Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models. Results: A model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed high prognostic accuracy; x2(5) = 109.12, p &amp;lt; 0.001, AUC = 0.86, p &amp;lt; 0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient&apos;s cooperation (R‐NC/TMD and HMD‐HE) exhibited good prognostic performance; x2(2) = 63.5, p &amp;lt; 0.001, AUC = 0.77, p &amp;lt; 0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%). Conclusions: A five‐variable model incorporating MLC, ULBT, HE, HMD‐HE and R‐NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R‐NC/TMD and HMD‐HE could be useful in incapable patients. The most accurate single predictor was HE. © 2020 Sociedade Brasileira de Anestesiologi