BACKGROUND Amoebic liver abscess (ALA) is the most common inflammatory space occupying lesion of the liver. It has a highly variable presentation causing diagnostic difficulties. Untreated, complicated ALA has high morbidity and mortality. OBJECTIVE To study the various types of clinical presentation and complications of ALA in order to establish early diagnosis and prevent complications. METHODS A prospective study was conducted in the Department of Surgery of Calcutta National Medical College and Hospital from July 2005 to June 2008. All patients with a confirmed diagnosis of ALA during this period were included in the study. RESULTS Seventy-two patients with 76 ALAs were studied over a 3-year period. The age ranged from 21 to 72 years (mean age being 43.64 years). There were 66 males (91.67% of the patients) and 6 females (8.33% of the patients). The (31-40 years) age group showed the highest incidence consisting of 40.28% of the cases. Pain was located most commonly in the right hypochondrium in 60 patients (83.33%). Fever was observed in 58 patients (80.56%). Solitary abscess cavity was present in 68 patients (94.44%). The right lobe alone accounted for 65 (85.53%) of the abscesses. The most common echo pattern encountered in ultrasonography was the echorich pattern in 54 (71.05%) abscesses. Forty-four patients (61.11%) gave history of alcohol consumption. Diagnosis was missed in 21 patients (29.17%), particularly in those with atypical presentations. The most common complication was pleuropulmonary in 24 patients (33.33%), followed by intraperitoneal rupture in 19 patients (26.39%). Other complications were jaundice (n = 11), ascites (n = 9), subhepatic effusion (n = 7), subphrenic abscess (n = 3) and intrapleural rupture (n = 2). Ultrasonography was useful in diagnosing ALA. Despite successful therapy 23 patients (31.94%) had residual abscess cavities on ultrasonography even after 6 months. CONCLUSIONS In an endemic area a patient presenting with lower chest or upper abdominal pain along with tender hepatomegaly should raise the suspicion of ALA. Sonography remains an important tool in the diagnosis of ALA.