A 32-year-old man from Bihar presents with fever, dull right upper quadrant pain and tender hepatomegaly. Ultrasound shows a solitary right-lobe collection with fine debris. Serology for Entamoeba histolytica IgG is positive. He is haemodynamically stable. The best initial treatment is:

• A Open surgical drainage via a subcostal incision
• B Ultrasound-guided pigtail catheter drainage plus metronidazole
• C Metronidazole therapy alone ✓
• D Broad-spectrum antibiotics covering Klebsiella alone

Explanation

Amoebic liver abscess responds dramatically to metronidazole, with clinical improvement within days, so drug therapy alone is adequate initial treatment in a stable patient; aspiration adds nothing routinely and risks secondary infection. Needle aspiration or catheter drainage is reserved for lack of response after 5 to 7 days, very large abscesses, left lobe abscess threatening pericardial rupture, or diagnostic uncertainty. Open drainage is obsolete except for rupture with peritonitis. Pyogenic abscesses need drainage plus antibiotics, but seropositivity here points to amoebic aetiology.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.