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A liver abscess presenting as bowel obstruction and perforation
1Accident and Emergency Department, Chelsea Westminster Hospital, London, UK. jan_rusman@yahoo.com
BMJ Case Reports
|April 24, 2013
Summary
A patient with vomiting and constipation was diagnosed with a large hepatic abscess, not bowel perforation. Percutaneous drainage and Streptococcus milleri treatment led to recovery.
Area of Science:
- Hepatology
- Infectious Diseases
- Radiology
Background:
- A 69-year-old male presented with cachexia, tachycardia, and hypotension.
- Symptoms included 7 days of vomiting and constipation, with a high white cell count and lactate levels.
Observation:
- Initial chest X-ray suggested free air under the diaphragm, raising suspicion for bowel obstruction with perforation.
- Abdominal CT scan revealed a large, fluid and gas-filled hepatic abscess and a smaller simple cyst.
Findings:
- The hepatic abscess was successfully drained percutaneously.
- Cultures of the purulent fluid identified Streptococcus milleri as the causative agent.
Implications:
- This case highlights the importance of advanced imaging in differentiating hepatic abscess from bowel perforation.
- Prompt diagnosis and percutaneous drainage are crucial for managing complex hepatic abscesses.
- Streptococcus milleri is an identified pathogen in pyogenic liver abscesses.
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