Ruptured Liver Abscess: A Rare Cause of Pneumoperitoneum
Ruptured Liver Abscess: A Rare Cause of Pneumoperitoneum
Ruptured Liver Abscess: A Rare Cause of Pneumoperitoneum
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<strong>Ruptured</strong> liver abscess231急 重 症 影 像<strong>Ruptured</strong> <strong>Liver</strong> <strong>Abscess</strong>: A <strong>Rare</strong> <strong>Cause</strong> <strong>of</strong><strong>Pneumoperitoneum</strong>Yuan Kao, Chung-Hsun Chuang, Wei-Jing Lee, Hung-Jung LinA 73-year-old man with past history <strong>of</strong>diabetes mellitus, hypertension and old cerebralvascular accident presented to the emergencydepartment with abdominal pain and fever forfew hours. Physical examination revealed diffuseabdominal tenderness and muscle guarding. Astanding chest X-ray showed bilateral subphrenicfree air (Fig. 1). Computed tomography <strong>of</strong> theabdomen was arranged and showed rupturedemphysematous liver abscess (Fig. 2). Emergentlaparotmy was arranged and revealed turbid asciteswith ruptured emphysematous liver abscess justunderneath right diaphragm. There were growth <strong>of</strong>Klebsiella pneumonia found in both the pus cultureFig. 1Some subphrenic free air (arrow) is notedbilaterally in the standing X-rayReceived: August 19, 2009 Accepted for publication: September 17, 2009From the Department <strong>of</strong> Emergency Medicine, Chi-Mei Medical CenterAddress reprint requests and correspondence: Dr. Wei-Jing LeeDepartment <strong>of</strong> Emergency Medicine, Chi-Mei Medical Center901 Chunghua Road, Yungkang City, Tainan County710, Taiwan (R.O.C.)Tel: (06)2812811 ext 57196 Fax: (06)2812811 ext 57178E-mail: saab931103@yahoo.com.tw
232J Emerg Crit Care Med. Vol. 21, No. 4, 2010Fig. 2Computed tomography <strong>of</strong> abdomen reveals a large gasforming liver abscess with intraperitoneal free airand the blood cultures . The patient was dischargedunder stable condition after the operation and acomplete course <strong>of</strong> antibiotics treatment.Subdiaphragmatic free air on the chest X-raydoes not necessarily indicate perforation <strong>of</strong> thestomach, intestine or hollow organ viscus. E.coliand K. pneumoniae are the most common pathogensisolated from emphysematous liver abscess thattend to rupture (1) . In Taiwan, K. pneumoniae is themost commonly isolated pathogen from pyogenicliver abscess in patients with diabetes mellitus (2) .Rupture <strong>of</strong> liver abscess is reportedly occurring in5.4% patients with liver abscess (3) . The treatmentsinclude drainage and antibiotic use. Correctdiagnosis and emergent operation should never belate, because <strong>of</strong> a 43.5% mortality rate had beenreported in patients with ruptured liver abscess (2-3) .References1. Lai YC, Su YJ, Chang WH. <strong>Ruptured</strong> hepaticabscess mimicking perforated viscus. Int JInfect Dis 2008;12:e95-7.2. Lee YL, Lee SS, Tsai HC, et al. Pyogenicliver abscess caused by Klebsiella pneumonia:analysis <strong>of</strong> the clinic characteristics ando u t c o m e s o f 84 p a t i e n t s. C h i n M e d J2007;120:136-9.3. Chou FF, Sheen-Chen SM, Lee TY,et al.Rupture <strong>of</strong> pyogenic liver abscess. Am JGastroenterol 1995;90:767-70.
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