Many a time, patients with amoebic liver abscess have presented with ascites and oedema of feet. Wilmot has not satisfactorily explained the cause of ascites.¹ Although hypoalbuminaernia is one of the factors, other factors like obstruction of inferior vena cava (which has been described elsewhere) and portal hypertension may also play a part.
The incidence of portal hypertension in patients with an amoebic liver abscess has been underestimated because a palpable spleen and engorged veins over the abdominal wall are very rarely seen.
Satyanarayana Rao² has recorded the intrasplenic pulp-pressure in 22 proved cases of amoebic liver abscess before and after the treatment. The intrasplenic pulp pressure before the treatment varied from 130 mm. to 245 mm. of blood with a mean of 182 mm., though clinically the spleen was palpable in one case only. There was a definite fall in every case after treatment. Thus, he proved that there was a rise, though temporary, of portal venous pressure in all his cases of amoebic liver abscess. He further noted that portal venous pressure was highest in cases with large abscesses. Moreover, it was significant that the collateral circulation, (in the form of oesophageal varices) due to increased portal venous pressure, was not demonstrable in any of his cases. This is not surprising as it has been shown that portal hypertension of short duration can exist without demonstrable collateral circulation.^3,4 What is difficult to explain, however, is that one of his patients had visible veins over the abdominal and chest wall. Since the direction of flow has not been mentioned, it is possible that these were due to the inferior vena caval obstruction. It is worth noting that oedema of feet and ascites were present in three of his cases.
While scanning patients with liver abscess, Lele et al⁵ found signs of portal hypertension (in the form of an enlarged spleen and excess of 99mTc sulphur colloid in the vertebral marrow) in few cases. After treatment, the spleen regressed.
The author has seen only 2 cases of an amoebic abscess where the spleen was palpable. It regressed after the aspiration of the amoebic liver abscess. In both the cases, the patients had huge abscesses. Figures 23 a,b show their liver scans. More than two litres of pus was aspirated from one of these patients.
The rise in portal venous pressure appears to be due to the pressure of the abscess over the portal vein radicles and their destruction in the region of the abscess. However, it usually does not produce any clinical signs.

References

1. Wilmot, A J, Clinical Amoebiasis, Blackwell Scientific Publications, Oxford, 1962.
2. Satyanarayana Rao, P. J. Ass. Phys. Ind., 1965, 5. 13.
3. Sherlock, S. "Portal Hypertension", Progress in Liver Diseases, Vol. I, Edited by Popper, H. and Schaffnex, F. Published by Grune and Stratton, New York, 1961.
4. Sherlock, S. Diseases of the Liver and Biliary System, 3rd Edition, Blackwell Scientific Publications, Oxford, 1963.
5. Lele, R D, and Nagarwala, H K, Bull. Jaslok Hos. Res. Centre, 1978, 2, 162.