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Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess

Maurizio Zizzo1, Claudia Zaghi2, Antonio Manenti3

  • 1Department of General Surgery, C.S. Surgical Oncology and Reconstructive Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.

International Journal of Surgery Case Reports
|June 29, 2016
PubMed
Abstract

Insights

Pyogenic liver abscess is a serious condition. In rare cases, rupture can be treated with antibiotics alone, especially when localized, avoiding emergency surgery.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Surgical Gastroenterology

Background:

  • Pyogenic liver abscess (PLA) is a rare but serious condition with high mortality (15-19%).
  • Standard treatment involves percutaneous drainage and antibiotics, with surgery reserved for select cases.
  • Spontaneous rupture of a liver abscess is a rare, critical event, often necessitating emergency surgery.

Purpose of the Study:

  • To report a rare case of a ruptured pyogenic liver abscess with spontaneous external drainage.
  • To highlight the successful non-surgical management of a localized liver abscess rupture.
  • To discuss the implications of abscess rupture location on treatment strategy.

Main Methods:

  • Case report of a 95-year-old female with fever and abdominal wall swelling.
  • Computed tomography (CT) confirmed a large abdominal wall mass continuous with a left hepatic lobe abscess.
  • Diagnosis of ruptured pyogenic liver abscess caused by Proteus mirabilis.

Main Results:

  • The patient presented with a large hepato-parietal abscess.
  • Spontaneous drainage of the abscess to the exterior occurred.
  • Successful treatment was achieved with antibiotics alone, without surgical intervention.

Conclusions:

  • Pyogenic liver abscess rupture is a life-threatening complication.
  • The location of rupture dictates management: free peritoneal rupture requires emergency surgery.
  • Localized rupture, as in this case, may be successfully managed with antibiotics and drainage, challenging the necessity of surgery in all rupture scenarios.
Keywords:
Abdominal wall abscessProteus mirabilisPyogenic liver abscessSpontaneous rupture

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