A Case of Ruptured Liver Abscess Refractory to Conservative Treatment That Was Successfully Treated by Hepatic Resection

Abstract

The patient, a 66-year-old woman, was referred to our hospital with a history of fever, abdominal pain and vomiting. Blood tests showed elevated inflammatory marker levels and abnormal liver and kidney function parameters. Abdominal CT showed a low-density area in the lateral segment of the liver, and abdominal ultrasonography showed a multifocal cyst measuring 70 mm in diameter in the same region. Based on the findings, we diagnosed the patient as having a liver abscess complicated by sepsis and DIC, and started on antimicrobial therapy; drainage of the abscess was difficult because it was multifocal and lacked liquid components. On day 5 of treatment, we noticed symptoms and signs of peritoneal irritation, and performed emergency surgery on the same day with the suspected diagnosis of peritonitis caused by rupture of the liver abscess. Intraoperatively, a large amount of bloody ascites and a hematoma on the liver surface were observed, and a fist-sized mass with a laceration of the hepatic capsule was found in liver S3. Lateral segment hepatectomy was performed. Histopathological examination of the resected specimen showed a ruptured liver abscess. Blood culture, ascitic fluid culture, as well as abscess fluid culture grew Klebsiella pneumoniae. The patient was discharged on day 18 after surgery. Liver resection could be an effective treatment for liver abscesses that are difficult to drain and refractory to conservative treatment, as in this case.