A Case of Ruptured Liver Abscess Caused by Clostridium Perfringens with Hemolysis Progressed Rapidly

Abstract

A 54-year-old man was admitted to our hospital with abdominal pain and fever lasting from the previous day. He had the past history of type 2 diabetes. Jaundice was noted and there was tenderness in the abdomen. Blood tests revealed strong hemolysis, high inflammatory reaction, and multiple organ failure. An abdominal computed tomography scan revealed a mass containing gas in the S5 of the liver and the presence of intraperitoneal free air. Acute generalized peritonitis due to rupture of a gas-producing liver abscess was suspected. We performed an emergency open drainage, while his respiratory condition rapidly deteriorated. We observed ascites with bad smell and rupture of the liver abscess during the surgery. After the surgery, we started intensive care for sepsis and multiple organ failure. Clostridium perfringens was isolated from ascites fluid on the 3rd postoperative day, and we started the administration of clindamycin. But he died on the forth day after the surgery. Hepatic abscess due to Clostridium perfringens is extremely rare, but it can rapidly progress to the termination. In the treatment of sepsis with hemolysis and gas-producing liver abscess. Clostridium perfringens should be kept in mind.