International Journal of Infectious Diseases
Volume 12, Issue 6 , Pages e95-e97, November 2008

Ruptured hepatic abscess mimicking perforated viscus

  • Yen-Chun Lai

      Affiliations

    • Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
  • ,
  • Yu-Jang Su

      Affiliations

    • Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei 112, Taiwan
    • Corresponding Author InformationCorresponding author. Tel.: +886 2 25433535x3126; fax: +886 2 27621403.
  • ,
  • Wen-Han Chang

      Affiliations

    • Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan

Received 22 April 2008; accepted 5 June 2008. published online 03 September 2008.

Corresponding Editor: William Cameron, Ottawa, Canada

Summary 

Background

In the majority of pneumoperitoneum cases we diagnose perforated viscus. We present herein a case of ruptured hepatic abscess mimicking perforated viscus.

Case report

A 40-year-old man presented to the emergency room with fever and right upper quadrant abdominal pain. The fever had been on/off for a period of 1 month. On physical examination, diffuse abdominal pain with rebounding tenderness was noted. Blood tests showed leukocytosis with left shift, hyperglycemia, and elevated liver function tests. A chest X-ray showed a subdiaphragmatic region air-fluid level, indicating a hepatic abscess. Pneumoperitoneum was also seen. Owing to the status of peritonitis, computed tomography (CT) of the abdomen was performed and revealed an air-containing liver abscess in the right lobe of the liver. Perforation of a hollow organ was also suspected because of the pneumoperitoneum. An emergent laparotomy was immediately performed for the suspicion of a hollow organ perforation. No perforation of the hollow viscus was found. The ruptured hepatic abscess was attributed to the pneumoperitoneum. A blood culture grew Klebsiella pneumoniae four days later, and the same organism was also found in a surgical specimen culture of the abscess.

Conclusions

For a ruptured hepatic abscess, surgical intervention with draining of the abscess and cleaning of the abdominal cavity are essential to save patient lives.

Keywords: Ruptured hepatic abscess, Hollow viscus perforation, Klebsiella pneumoniae, Peritonitis, Chilaiditi's syndrome

 

PII: S1201-9712(08)01390-8

doi:10.1016/j.ijid.2008.06.005

International Journal of Infectious Diseases
Volume 12, Issue 6 , Pages e95-e97, November 2008