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Successful Medical Treatment for Peritonitis Resulting from a Large Pyogenic Liver Abscess Rupture
Hee Jun Myung1, Soo Hyung Ryu1, Chung Hao Liu1
1Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Abstract:
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.
Insights
Ruptured pyogenic liver abscess (PLA) with peritonitis is a critical condition. This case demonstrates successful medical management with antibiotics and drainage, offering an alternative to surgery for high-risk patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Emergencies
Background:
- Pyogenic liver abscess (PLA) rupture with peritonitis is a rare but life-threatening surgical emergency.
- Gas-forming PLA carries a particularly high mortality rate.
- While surgical intervention is standard, complete recovery with medical management alone has been documented in rare instances.
Observation:
- This report details a case of a large PLA rupture with generalized peritonitis.
- The patient, elderly and in poor general health, was deemed too high-risk for surgical intervention.
- The patient received appropriate antibiotic therapy and underwent sufficient percutaneous drainage.
Findings:
- The patient achieved a full recovery without surgical intervention.
- This outcome suggests that medical management can be effective in specific PLA rupture cases.
- Percutaneous drainage combined with antibiotics proved sufficient for resolution.
Implications:
- Medical management, including antibiotics and percutaneous drainage, should be considered for ruptured large PLA with peritonitis in patients unsuitable for surgery.
- This approach may offer a viable alternative, potentially reducing surgical risks and improving outcomes in select high-risk populations.
- Further research into non-operative management strategies for complicated PLA is warranted.
