A Case Report: Ruptured of Pyogenic Liver Abscess

Abstract

Background: Most causative of liver abscess, in about 90% of all cases, are pyogenic abscess. One of the rare and dangerous complications of pyogenic liver abscess (PLA) that requires urgent management, even with nonspecific signs and symptoms, is abscess rupture. Case Presentation: A 27 years old male patient came to the hospital with persistent right upper abdominal pain. The pain started one week ago after the patient fell from the stairs, where the right side of the abdomen hit the stairs. Abdominal ultrasound revealed heteroechoic lesion with ill borders, irregular margin, and internal moving echo (+) in the right lobe of the liver, which on color doppler examination showed minimal perilesional vascularization. The patient underwent abdominal computed tomography (CT) scan with contrast four days later with showed rim enhancing semisolid lesion (23-33 HU) with air density (-925 HU) within it in, in the segments V to VIII of the right lobe of the liver partially ruptured in the periphery of segments VI-VII of the liver lobe with pneumoperitoneum and ascites. A week later, a laparotomy was performed, and the culture of the pus specimen revealed growth of Escherichia coli. Conclusion:Based on clinical symptoms and imaging, PLA is not without any challenges in diagnosis. The key to avoiding misdiagnosis of ruptured PLA is a meticulous examination of the clinical and imaging also vigilant monitoring.