Pneumoperitoneum caused by ruptured gas-containing liver abscess

Shiba, Hiroaki; Aoki, Hiroaki; Misawa, Takeyuki; Kobayashi, Susumu; Saito, Ryota; Yanaga, Katsuhiko

doi:10.1007/s00534-006-1136-y

Cited by 16 publications

(7 citation statements)

References 8 publications

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“…Less common sources include other intra-abdominal, gynecologic, or urologic diseases. 6,[8][9][10][11][12] On occasion, certain conditions may mimic pneumoperitoneum, including subphrenic abscesses, colonic volvulus, and Chilaiditi's syndrome, where a loop of colon is interposed between the liver and the diaphragm. 13 In our case, no perforation of the gastrointestinal tract was found at laparotomy, and the pus obtained during the procedure grew pure K. pneumoniae, indicating that rupture of the abscess accounted for the pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Ruptured hepatic abscess mimicking perforated viscus

Lai

Chang

2008

International Journal of Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Ruptured hepatic abscess mimicking perforated viscus

Lai

Chang

2008

International Journal of Infectious Diseases

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“…Instead of that, they cut the part of liver which contained abscess and cleaned the abdominal cavity. Their patient recovered well after surgery without any complication and discharged at the postoperative day 30 [16]. In our case, partial hepatectomy was not conducted to remove the abscess.…”

Section: Discussionmentioning

confidence: 74%

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

et al. 2020

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Background Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management. Clinical spectrum of GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Up to now, GFPLA has not been well studied in Vietnam. Case presentation We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 41-year-old man with a history of treated duodenal ulcer and uncontrolled type II diabetes mellitus. He had an epigastric pain 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 4 cm × 4 cm pus-containing abscess in the left liver lobe of the liver. The abscess was ruptured. Pus was running into abdominal cavity through one hole. The abscess and abdominal cavities were cleaned up and abscess and abdominal drainages were performed. K. pneumoniae was isolated from culture of the abscess. The histopathological examination of the abscess did not yield any evidence of malignancy. Blood glucose levels were controlled. Antibiotic therapy was used according to antibiogram. A reassessment chest X-ray showed no air-fluid level or subdiaphragmatic air by the hospital day 14. Patient eventually made a full recovery and was discharged home 23 days after the operation. Conclusions Ruptured GFPLA is a life-threatening complication. It is usually accompanied by peritonitis and pneumoperitoneum and can imitate hollow viscous perforation. In these cases, CT scan should be performed whenever it is possible to make a correct diagnosis. When the abscess has small size, partial hepatectomy might not be necessary and could be replaced by a careful cleaning and drainage of the abscess. Patient could show a good postoperative recovery following an appropriate antibiotic therapy.

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“…With the development of new imaging techniques and interventional technologies, it was found that, in the absence of diffuse peritonitis, percutaneous drainage of localized purulent collections forming subdiaphragmatic or perihepatic/subhepatic abscesses can be performed successfully [31], in the same way as laparoscopic drainage. However, in cases similar to the one described here, laparotomy with debridement and drainage of the abscess cavity (and sometimes liver resection [32,33]) remains an indispensable option of surgical treatment.…”

Section: Discussionmentioning

confidence: 82%

Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy

et al. 2019

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Patient: Male, 42 Final Diagnosis: Ruptured liver abscess • local peritonitis Symptoms: Severe abdominal pain • fever with a body temperature of 39°C • jaundice and severe weakness Medication: — Clinical Procedure: Laparotomy, drainage of the liver abscess Specialty: Surgery Objective: Rare co-existence of disease or pathology Background: Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. Case Report: A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40 th day and the subdiaphragmatic drains were removed on the 114 th day. Sixteen months after surgery, the patient’s condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. Conclusions: A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.

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Pneumoperitoneum caused by ruptured gas-containing liver abscess

Cited by 16 publications

References 8 publications

Ruptured hepatic abscess mimicking perforated viscus

Ruptured hepatic abscess mimicking perforated viscus

Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report

Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy

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