A Case of Liver Abscess Caused by Migration of Ascaris Lumbricoides

蛔蟲的迷走所致的肝膿瘍之一病例

黃富源(Fu-Yuan Huang) ； 許瑞雲(Jei-Yun Hsu) ； 陳秋江(Chiou-Chian Chen)

《Acta Paediatrica Sinica》 13卷1期 (1972/03) Pp. 18-25

摘要

一個14月大的男孩住於新竹縣鄉下農村，因3個星期以來有發高熱，呼吸困難及上腹部漸漸脹大，於民國60年3月10日來臺大醫院急診處。經診察、X光檢查被認為右肺炎胸膜炎及肝膿瘍而住進小兒科病房。由右胸腔穿刺得到50cc黃色滲出液，可是除了少數紅血球及白血球以外沒發現任何細菌及其他病原體。肝臟穿刺得到2cc膿血樣液而發現多數蛔蟲卵及膿細胞又由培養證明其中有大腸菌。3月18日第一次肝臟排膿手術時發現肝右葉有3個膿瘍經檢查發現含有蛔蟲卵及大腸菌並取出7條活的蛔蟲。其後經導管從肝膿瘍流出2條蛔蟲。沒有腹膜炎或膈下膿瘍的現象。當第一次肝臟排膿手術後雖繼續注射Prostaphlin，Kanamycin，Pentrexyl又內服Prednisolone及Bexin，但肝臟一直不縮小，發熱不退而一直有白血球增多症。於4月2日再施行第二次手術發現2條死的蛔蟲在陳舊肝膿瘍裡又有1條活的蛔蟲在總輸膽管內，並沒找到另外新發生的膿瘍。其後注射Garamycin，Prostaphlin內服Diclocil，Bexin，Prednisolon等，對發熱白血球增加症蛔蟲卵均沒有見效，於4月23日起改用Santonin內服Keflex及注射Streptomycin，Penicillin後肝之炎症漸漸消退，白血球數恢復正常，大便中蛔蟲卵也於用Santonin兩天後消失而於5月18日痊癒出院。
國外文獻上雖有關於蛔蟲所致的肝膿瘍之報告，本例在臺灣尚為第一例臨床報告。

並列摘要

A 14-month-old boy living in a rural community suffered from high fever, dyspnea and progressive distension of the abdomen for 3 weeks. He was admitted to the pediatric ward of National Taiwan University Hospital under the diagnosis of bronchopneumonia with pleurisy and liver abscess on March 10, 1971, Fifty cc of yellowish exudate was drawn out from the right pleural cavity but no pathogen was found. Many ascaris ovae and numerous pus cells but no ameba were found from the sanguineous purulent punctate of the right lobe of the liver. Seven cords of live ascaris worms were evacuated from three abscess cavities in the liver at the first surgical operation and 2 live worms during the continuous drainage of the abscesses. At the second operation, 2 dead ascaris worms from the abscess cavities and one live worm from the common bile duct were picked out.