1887
2 - Qatar Health 2021 Conference abstracts
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Liver abscesses are common in the Emergency Department1. A cross-sectional study conducted in Qatar showed pyogenic liver abscesses were more common than amebic abscesses2. Spontaneous rupture of pyogenic liver abscess is a rare entity with serious complications. A rupture resulting in peritonitis requires urgent surgical intervention whereas localized abscesses are managed with surgical or image-guided percutaneous drainage in addition to appropriate antibiotics3. We report a case of spontaneous rupture of liver abscess presented to our Emergency Department that mimicked perforated hollow viscus. A 58-year-old male patient presented with fever, generalized weakness, anorexia, and abdominal discomfort for 2 weeks. The patient had a history of Type 2 diabetes mellitus and taking oral hypoglycemics. His initial vital signs revealed a temperature of 38.2°C, heart rate of 104 beats per minute, blood pressure of 150/74 mmHg, respiratory rate of 26 breaths per minute, oxygen saturation of 96% on room air. He appeared sick and dehydrated. Pertinent findings on abdominal examination were epigastric and right upper quadrant tenderness. The laboratory report showed leucocytosis and elevated transaminase. A chest X-ray was ordered and revealed air under the diaphragm (Figure 1).

Point of care ultrasound showed a right liver lobe hypoechoic lesion with internal echoes and surrounding free fluid (Figure 2).

A computed tomography of the abdomen showed a large hepatic lesion (11.5 x 8.5 x 9 cm), subcapsular in location, containing gas with dependent fluid, suggesting a gas-forming hepatic abscess, with the possibility of rupture and pneumoperitoneum. The patient was admitted and underwent ultrasound guided drainage of the abscess. His blood and pus culture showed Klebsiella pneumonia and he received Ceftriaxone and Metronidazole intravenously (IV) for 14 days. He was discharged after 15 days with a favorable outcome. To the best of our knowledge, spontaneous liver abscess rupture resulting in pneumoperitoneum is rare. Chest X-ray findings may mimic perforated hollow viscus.

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/content/journals/10.5339/jemtac.2021.qhc.26
2021-08-23
2021-09-27
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References

  1. Liu L, Chen W, Lu X, Zhang K, Zhu C. Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China. J Emerg Med. 2017; 52:(4):409–416.
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  2. Abbas MT, Khan FY, Muhsin SA, Al-Dehwe B, Abukamar M, Elzouki AN. Epidemiology, Clinical Features and Outcome of Liver Abscess: A single Reference Center Experience in Qatar. Oman Med J. 2014; 29:(4): 260–3.
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  3. Jun CH, Yoon JH, Wi JW, Park SY, Lee WS, Jung SI, et al. Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess. J Dig Dis. 2015; 16:(1):31–6.
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  • Article Type: Conference Abstract
Keyword(s): liver abscess , perforated viscus , pneumoperitoneum , pyogenic and rupture
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