XII, B, 3 Abriol: Amcebic Abscess of the Liver 139 



a typical acute peritonitis is produced. Dudley (31) reports a 

 case of this kind with operation and recovery. Rupture into 

 the pleural cavities or pericardium, into the lungs, into the 

 stomach or colon, into the right kidney, and into the portal 

 vessels may take place, giving rise to symptoms referable to 

 the particular structure involved. Cyr(32) gives the results of 

 various observers as follows: Rupture into lung, 59; pleura, 

 31; pericardium, 1; peritoneum, 39; stomach, 8; intestines, 13; 

 kidney, 2; inferior vena cava, 3; bile passages, 4; externally, 2. 

 Craig, (18) in 7 cases, reported 2 ruptures into the pericardium 

 and 5 into the pleura. In our series 6 of 12 fatal cases had 

 ruptured spontaneously, 4 of these into the peritoneum and 1 

 into the pleura. 



Another peculiar complication of liver abscess is intestinal 

 hemorrhage, ending fatally as a rule. Reports on this compli- 

 cation occur in cases with active lesions in the colon. Strong (33) 

 reports four cases which terminated fatally. Two of our cases 

 presented this complication, one without operation, which ended 

 fatally. In the other case a hemorrhage in the abscess cavity 

 occurred one month after operation, and this was followed 

 twenty-four hours later by hemorrhage from the intestines, 

 about 200 cubic centimeters of bright red blood having been 

 passed per rectum. Elevation of the lower part of the bed, 

 packing the abscess cavity with gauze, administration of emetine 

 hydrochloride intravenously, and subcutaneous injection of nor- 

 mal horse serum saved the patient. 



PROGNOSIS 



Amoebic liver abscess runs a course of varying length. Man- 

 son (i) says that generally it is an affair of several months. If 

 proper treatment is instituted early, its course is greatly short- 

 ened. If it ruptures, the termination varies with the nature 

 of the visceral involvement. Ruptures occurring into the lungs, 

 stomach, and intestines usually result favorably. At times, 

 small abscesses become encysted or absorbed and thus end in 

 recovery. The coexistence of intestinal amoebiasis, intestinal 

 hemorrhage, broken down state of constitution, and multiplicity 

 of the abscesses add materially to the gravity of the disease. 

 Likewise the existence of mixed infection renders the outlook 

 less favorable. 



The death rate among Europeans is high, but is comparatively 

 low among those who come early under observation. Table VII 

 shows a comparison of the percentage of mortality as given 

 by various observers. 



