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Unusual pneumoperitoneum secondary to ruptured liver abscess-A case report
1Dept of General Surgery, Sapthagiri Institute of Medical Sciences & Research Centre, Karnataka, 570001, India.
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.
Insights
Ruptured pyogenic liver abscess can cause pneumoperitoneum, mimicking hollow viscus perforation. Early diagnosis and treatment are crucial for survival, as this rare condition can be fatal.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Pyogenic liver abscess is a significant cause of morbidity and mortality, particularly in low-middle income countries.
- Ruptured liver abscess can present with pneumoperitoneum and peritonitis, mimicking gastrointestinal perforation.
Observation:
- A case of a 27-year-old male with uncontrolled type II diabetes mellitus presenting with abdominal pain, distension, fever, peritonitis, and pneumoperitoneum.
- Emergency laparotomy revealed a ruptured liver abscess, not a perforated hollow viscus.
- The patient developed septic shock and unfortunately demised despite intensive care and antibiotic therapy.
Findings:
- Pneumoperitoneum secondary to a ruptured, gas-containing pyogenic liver abscess is a rare but life-threatening condition.
- Clinical presentation and imaging, especially CT scans, are vital for differentiating this from hollow viscus perforation.
Implications:
- Prompt and accurate diagnosis, including appropriate imaging and clinical suspicion, is essential.
- Effective management requires adequate source control (drainage) and targeted antibiotic therapy.
- Timely surgical intervention and antibiotic treatment are critical for improving patient outcomes in such rare cases.
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