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Case Reports
. 2021 Jul-Aug;11(4):506-510.
doi: 10.1016/j.jceh.2020.09.004. Epub 2020 Oct 24.

Undiagnosed Hepatic Tuberculosis Presenting With Intraabdominal Rupture and Hemoperitoneum, Requiring Urgent Hepatic Resection

Shitesh Malewadkar  1 , Vivek Shetty  1 , Soumil Vyas  2 , Nilesh Doctor  1
Affiliations
Case Reports

Undiagnosed Hepatic Tuberculosis Presenting With Intraabdominal Rupture and Hemoperitoneum, Requiring Urgent Hepatic Resection

Shitesh Malewadkar et al. J Clin Exp Hepatol. 2021 Jul-Aug.

Abstract

Tuberculosis (TB) affecting the liver is unusual, and isolated liver TB presenting as a liver abscess more so, even in countries where the disease is endemic. As clinical symptoms and imaging are not typical, a high index of suspicion is necessary for diagnosis. We present here a lady who was admitted with fever and chills. Ultrasound imaging showed a liver abscess. She developed bleeding into the abscess cavity, necessitating an emergency right liver resection. Final histology confirmed mycobacterial granulomatous infection of the liver. Isolated hepatic abscess of tubercular origin is a rare cause of hemorrhage but should be considered as a differential diagnosis. Suspicious features on computerized tomography (CT) scan should prompt microbiological assessment of aspirate from the abscess, establishing the diagnosis, so appropriate treatment can be started, avoiding such complications.

Keywords: CT Scan, Computed Tomography; DSA, Digital Subtraction Angiography; ELISA, Enzyme-Linked Immunosorbent Assay; PCR, Polymerase Chain Reaction; TB, Tuberculosis; abscess; hemorrhage; hepatectomy; liver; tuberculosis.

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Figures

Figure 1
Figure 1
CT scan showing the liver abscess and lesion. CT, computerized tomography.
Figure 2
Figure 2
Angiogram images A: Portal phase of the angiogram showing nonvisualization of the posterior portal pedicle. B: Arterial phase showing no obvious extravasation or blushing.
Figure 3
Figure 3
Intraoperative images of the liver abscess and lesion.
Figure 4
Figure 4
Right hepatectomy.
Figure 5
Figure 5
Histology microphotograph (H & E) confirming mycobacterial infection.
See this image and copyright information in PMC

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