Spontaneous Cutaneous Rupture of a Pyogenic Liver Abscess

Abstract

Spontaneous rupture of a pyogenic liver abscess is a rare entity reported. Spontaneous cutaneous rupture of a pyogenic liver abscess is even a rarer clinical entity not well documented in the literature. A patient having spontaneous cutaneous rupture of a pyogenic liver abscess is reported. The condition is rare and serious because of the possible delay in diagnosis. Recently, with the advent of ultrasound (USG) and computed tomography (CT) scan, there has been improvement in the rate of early diagnosis of liver abscess as well as in prognosis. The clinical presentation is variable; in some cases there are delays, misdiagnoses, or incidental recovery. Per cutaneous catheter drainage under USG or CT guidance has become the standard of care.

Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess

“…However, as shown in our patients, the outcomes are also dependent on other factors such as the location of rupture and other underlying conditions. The sites of rupture include the subphrenic and peri‐hepatic regions, peritoneum, pleura, skin, mediastinum and pericardium . A rupture into the bowel, pericardium or mediastinum is rare.…”

Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess

“…The invasion of the liver parenchyma occurs through the bile ducts (cholelithiasis, obstructive biliary tree tumors, stenosis, congenital malformation), portal venous system (appendicitis or diverticulitis), arterial blood (endocarditis or pyelonephritis) or contiguity, in particular through the bed of the gallbladder. It can also result from a penetrating or non-penetrating liver trauma, a secondary infection of amoebic abscesses, cavities hydatid cysts, metastases and primary liver tumors or a complication of liver transplantation or hepatic artery embolization [2] , [9] .…”

“…Right hepatic lobe is affected more often than the left one (2:1), while bilateral involvement occurs in 5% of cases [9] .…”

“…We performed an extensive literature search about the rupture in the abdominal wall of a PLA and we have identified only two other cases ( Table 1 ). In the case described by Kawoosa et al [9] , the patient was a young woman with a history of previous laparotomy for PLA, with a multiple PLA of the right hepatic lobe caused by Klebsiella pneumoniae , spontaneously ruptured into right upper quadrant wall and treated with percutaneous drainage and antibiotics. In the case described by Belabbes et al [14] the patient was an old woman, with no comorbidities, with a bulky abscess of the left hepatic lobe (not identified a pathogen), that spontaneously ruptured into epigastric-umbilical wall and treated with percutaneous drainage and antibiotics.…”

Dolor abdominal: causas poco frecuentes

“…39 El riesgo de mortalidad en pacientes no tratados puede llegar al 100%, 40 por lo que es importante hacer un diagnóstico temprano; sin embargo los síntomas son inespecíficos, se ha descripto una triada clásica de fiebre, dolor de espalda y espasmos del psoas en el 30% de los pacientes. 41 La TC con contraste es el método de elección para el diagnóstico. 38,42 Las imagenes muestran una lesión hipodensa con realce en anillo en el músculo psoas (►Fig.…”