Successful Medical Treatment for Peritonitis Resulting from a Large Pyogenic Liver Abscess Rupture

Abstract

The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported. This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient's age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.

Keywords: Klebsiella pneumoniae; Liver abscess; Peritonitis; Rupture; pyogenic.

Fig. 1

Computed tomography (CT) scan of the abdomen. (A, B) Initial abdominal CT shows massive, multiple abscesses in the right lobe of the liver.

Fig. 2

Computed tomography (CT) scan of the abdomen. (A, B) On hospital day 2, a CT scan revealed rupture of the liver abscess in the peritoneal cavity, pleural space, and pararenal space (arrow). (C, D) The percutaneous catheter drainage tip is located in the perihepatic space (arrow).

Fig. 3

Computed tomography (CT) scan of the abdomen. (A, B) On hospital day 6, the CT scan showed air bubbles (arrow of A) and a decrease in abscess size.

Fig. 4

Computed tomography (CT) scan of the abdomen. (A, B) On hospital 44, the CT scan shows a significant size reduction of the abscess and diminished fluid collection.