Ruptured pyogenic liver abscess with free air in the abdominal cavity: a case report

Abstract

An 84-year-old woman was admitted for abdominal pain with high fever. Abdominal CT revealed a liver abscess which contained gas in the right hepatic lobe. Moreover, massive ascites and free air were present in the abdominal cavity. Based on those findings, we suspected diffuse peritonitis due to gastrointestinal perforation and liver abscess. Thus, emergency operation was performed. A ruptured abscess was recognized in the segment 8 of the liver with-out perforated intestine. Thus, peritoneal lavage and drainage were performed. Bacterial examination of the abscess demonstrated Klebsiella pneumoniae. The patient received intensive care after surgery due to septic shock, and recov-ered gradually despite recurrence liver abscess of in same location, and was discharged on the 67th day after the operation. It is important to consider perforated liver abscess as a differential diagnosis of peritonitis with free air.