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Abdomen CT scan shows: bulky abscess of the anterior abdominal wall of 12 cm × 14 cm × 7 cm (arrows).
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Introduction
Pyogenic liver abscess is a rare cause of hospitalization, related to a mortality rate ranging between 15% and 19%. Treatment of choice is represented by image-guided percutaneous drainage in combination with antibiotic therapy but, in some selected cases, surgical treatment is necessary. In extremely rare cases, spontaneous rupture of...
Citations
... Abdominal wall abscesses can manifest as an extension of intra-abdominal processes or as primary infections [4][5][6][7]. Risk factors include surgery, hematomas, diverticulitis, cholecystitis, appendicitis [7], and Crohn's disease [5]. ...
... Abdominal wall abscesses can manifest as an extension of intra-abdominal processes or as primary infections [4][5][6][7]. Risk factors include surgery, hematomas, diverticulitis, cholecystitis, appendicitis [7], and Crohn's disease [5]. ...
... Abdominal wall abscesses present on US as superficial fluid-filled complex lesions, with ill-defined margins, predominantly hypoechoic to surrounding muscles [7,8]. Peripheral hyperemia can be seen on Color Doppler US (CDUS) [3] (Figure 1). ...
The abdominal wall is the location of a wide spectrum of pathological conditions, from benign to malignant ones. Imaging is often recommended for the evaluation of known palpable abdominal masses. However, abdominal wall pathologies are often incidentally discovered and represent a clinical and diagnostic challenge. Knowledge of the possible etiologies and complications, combined with clinical history and laboratory findings, is crucial for the correct management of these conditions. Specific imaging clues can help the radiologist narrow the differential diagnosis and distinguish between malignant and benign processes. In this pictorial review, we will focus on the non-neoplastic benign masses and processes that can be encountered on the abdominal wall on cross-sectional imaging, with a particular focus on their management. Distinctive sonographic imaging clues, compared with computed tomography (CT) and magnetic resonance (MR) findings will be highlighted, together with clinical and practical tips for reaching the diagnosis and guiding patient management, to provide a complete diagnostic guide for the radiologist.
... However, the abscess was confined without abdominal wall NSTI. 3 Therefore, this is the first reported case of spontaneous NSTI of the abdominal wall due to direct LA invasion. ...
... Information regarding articles with respect to pyogenic liver abscess rupture in the abdominal wall.[19][20][21] ...
... International Surgery Journal | November 2021 | Vol 8 | Issue 11 Page 3487 communication presenting as lumbar mass and the SECOND case of cutaneous rupture of the right lobe liver.[19][20][21] ...
Pyogenic liver abscess was first reported in the writings of Hippocrates, which was based on the type of fluid recovered from the abscess related to a high mortality rate ranging between 15% and 19% at that time. However in 1938, Ochsner and De Bakey described the recommended surgical treatment as the primary treatment modality. Surgery remained the therapy of choice until the mid-1980s, when percutaneous drainage was shown to be a safer alternative in many cases. Spontaneous rupture of liver abscess may occur free in the peritoneal cavity or in neighbouring organs, an event which is generally considered as a surgical emergency, while localized rupture can be managed with drainage, either percutaneous or surgical/minimal invasive techniques and addition of appropriate antibiotic treatment. In cases where there is uneventful rupture of abscess and localized to the neighbouring organs and tissues can be successfully treated by a combination of broad-spectrum antibiotics and percutaneous drainage and endoscopic management.
... Liver abscess is one of the oldest surgical emergencies, described from the time of Hippocrates. 1 Of the complications associated with it, rupture into the anterior abdominal wall is an unusual event and can lead to increased morbidity and mortality. 2,3 Much has evolved in their management with lesser invasive procedures being the standard of care. Consequently, liver abscess, which was primarily a surgical condition, is now easily being managed by interventional radiologists. ...
... Rupture of pyogenic liver abscess is a rare complication that can lead to increased morbidity and mortality. 2 The other reports of abdominal wall abscess secondary to a pyogenic liver abscess are summarized in Table 2. The associated factors are postulated to be Klebsiella infection, diabetes mellitus, gas formation in the cavity, and involvement of the left lobe of the liver. ...
... In general, this is considered a surgical emergency but the management largely depends on the site of rupture and condition of the patient. 2,3,17,18 Following a USG-guided localization, we were able to successfully access the abscess cavity with a small skin incision using local anesthesia. Instead of a pigtail catheter, a foley catheter was used which is easily available in all rural surgical centers. ...
Liver abscess continues to be a major surgical burden in low and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic lady with a past history of laparoscopic cholecystectomy presented with acute pain in the right upper quadrant. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with USG guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited rural surgical centers. The patient’s clinical presentation, investigations, and management have been discussed with a relevant review of the literature.
... 8 In another case, ruptured PLA measuring 12 cm ×14 cm×7 cm was treated with antibiotics and PCD; however, it was localized in the neighboring tissues. 16 In the present case, the abscess size was 17 cm in diameter. Although the abscess size was large and was accompanied by peritonitis with rupture, antibiotic therapy and PCD were administered instead of surgical treatment, considering the patient's age and poor general condition. ...
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.
... Pyogenic liver abscess (PLA) is important cause of hospitalization and life threatening disease in low-middle income countries [6,18]. Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management [3]. ...
... Pyogenic liver abscess (PLA) is a common infectious disease worldwide relating to a mortality rate ranging between 15 and 19% [15,18]. Gas-forming pyogenic liver abscess (GFPLA) remains one of the most dangerous complication with a high fatality rate in spite of aggressive management [10]. ...
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.
... The most commonly localization rupture is the pleural, peritoneal cavities and more rarely in the pericardial cavity, the mediastinum or the intestines [6]. Rupture in the abdominal wall is rare in children and the few observations described in the literature have occurred in adults or newborns [7][8][9]. ...
... Anatomical factors may explain the rare location of rupture at the abdominal wall. Indeed, the abscess site at the left lobe suggests a progression to the abdominal wall by the falciform ligament with a large lymphatic and arterial network [7]. This hypothesis could explain its occurrence in our observation, where the abscess was in segments II and III which are close to the origin of the falciform ligament. ...
... Surgery is the treatment of choice for ruptured liver abscesses [2]. When rupture occurs in the pleura, pericardium, or abdominal wall, percutaneous drainage with appropriate antibiotherapy may be effective [7]. In addition, the major diameter and the site on the left lobe of the abscess are also criteria for echo-guided drainage even in the absence of rupture [1,4]. ...
Pyogenic liver abscess is a serious condition that can be lifethreatening because of its complications. This disease is not frequent in children [1]. Early diagnosis through imaging has improved prognosis [2]. Spontaneous rupture in the abdominal cavity or the adjacent organs constitutes the main complication. However, the rupture in the abdominal
wall is rare [3]. The rarity of liver abscess in children makes this clinical entity not much described in the literature. We report a case of spontaneous rupture of a pyogenic liver
abscess in the abdominal wall in children.
... The rupture in the pericardial cavity, the mediastinum or the bowel is rare [6]. Rupture in the abdominal wall is rare with few cases reported in the literature [8][9][10]. ...
... The unusual localization of the rupture to the abdominal wall can be explained by anatomical factors. The site of the abscess at the left lobe suggests progression to the abdominal wall by the falciform ligament which have with a large lymphatic and arterial network [10,12]. ...
... However, this depends more on the site of rupture. When localized in the pleura, pericardium or abdominal wall, percutaneous drainage with appropriate antibiotherapy may be sufficient [10]. ...
Background: Pyogenic liver abscess is defined as a suppurated cavity caused by the invasion and multiplication of bacterial microorganisms in the liver parenchyma. Pyogenic liver abscess rupture in the abdominal wall is rare.
Introduction
Pyogenic liver abscess is important cause of hospitalization and life threatening disease in low-middle income countries. Clinical spectrum of ruptured GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis.
Case presentation
We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 27-year-old man with a history of uncontrolled type II diabetes mellitus. He had an abdominal pain, distension of abdomen 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 ruptured liver abscess in the right lobe of the liver.. The patient was in septic shock and hence shifted to ICU with inotropic support. Antibiotic therapy was started according to pus culture sensitivity. Even with the above treatment patient was not improved and on 4th postoperative day the patient collapsed and declared dead.
Discussion
Pneumoperitoneum secondary to ruptured gas containing pyogenic liver abscess is rare and could represent as life threatening infection. It should be distinguished from perforation of hollow organ by clinical symptoms and image examinations, particularly like CT. Accurate diagnosis with adequate drainage and antibiotic therapy would bring good outcome.
Conclusion
We are aware that not every case of pneumoperitoneum is attributable to a perforated hollow viscus. A rapid and prompt surgical intervention with appropriate antibiotics are essential to save a life.
