[Peritonitis from liver abscess: retrospective study of 5 cases]

To report the clinical, paraclinical and therapeutic aspects of peritonitis from liver abscess and to study the risk factors of rupture

From January 2000 to March 2007, we retrospectively studied 5 cases of peritonitis secondary to ruptured of liver abscess at the surgery department of the University Teaching Hospital Le Dantec. These cases were selected among 48 cases of liver abscess managed during the same period.

There were four men and one woman. The mean age was 40.5 years. In 4 cases the Peritonitis was generalised and it was localised in one case. Percutaneous needle aspiration was already performed in 2 cases in a medical department. The abscesses were located in the right hepatic lobe in 3 cases and in left hepatic lobe in 2 cases. The mean diameter of the collection was 10.6 cm with extreme of 8 cm and 15 cm. The right liver abscesses were larger than the left ones (12.3 cm versus 8 cm). There were 2 cases of amoebic liver abscess and 3 cases of pyogenic liver abscess. All our patients underwent resuscitation prior and after the surgical treatment which consisted of abscess evacuation, peritoneal lavage and drainage. We noticed one case of recurrence successfully treated with antibiotics and percutaneous drainage. No death was recorded.

The big size of the abscess, the superficial location or on left hepatic lobe are risk factors of rupture. It justifies the necessity of instrumental evacuation of large hepatic abscess. Surgical drainage offer better results than other modalities in management of ruptured liver abscess.