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Case Reports
. 2020 Oct 7;20(1):228.
doi: 10.1186/s12893-020-00858-w.

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

Thuong Pham Van  1 , Son Vu Ngoc  1 , Ngoc Anh Nguyen Hoang  1 , Doan Hoang Huu  1 , Tung Anh Dinh Duong  2
Affiliations
Case Reports

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

Thuong Pham Van et al. BMC Surg. .

Abstract

Background: Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management. Clinical spectrum of GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Up to now, GFPLA has not been well studied in Vietnam.

Case presentation: We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 41-year-old man with a history of treated duodenal ulcer and uncontrolled type II diabetes mellitus. He had an epigastric pain associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a 4 cm × 4 cm pus-containing abscess in the left liver lobe of the liver. The abscess was ruptured. Pus was running into abdominal cavity through one hole. The abscess and abdominal cavities were cleaned up and abscess and abdominal drainages were performed. K. pneumoniae was isolated from culture of the abscess. The histopathological examination of the abscess did not yield any evidence of malignancy. Blood glucose levels were controlled. Antibiotic therapy was used according to antibiogram. A reassessment chest X-ray showed no air-fluid level or subdiaphragmatic air by the hospital day 14. Patient eventually made a full recovery and was discharged home 23 days after the operation.

Conclusions: Ruptured GFPLA is a life-threatening complication. It is usually accompanied by peritonitis and pneumoperitoneum and can imitate hollow viscous perforation. In these cases, CT scan should be performed whenever it is possible to make a correct diagnosis. When the abscess has small size, partial hepatectomy might not be necessary and could be replaced by a careful cleaning and drainage of the abscess. Patient could show a good postoperative recovery following an appropriate antibiotic therapy.

Keywords: Case report; Klebsiella pneumoniae; Pneumoperitoneum; Ruptured liver abscess.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Figures

Fig. 1
Fig. 1
Gas under both domes of diaphragm on radiograph. Routine preoperative X-ray taken on admission showed free gas under both domes of diaphragm (arrows)
See this image and copyright information in PMC

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