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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 223-224

A case of ruptured liver abscess manifesting with intestinal obstruction


Department of General Surgery, MVJ Medical College, Hoskote, Bengaluru, Karnataka, India

Date of Web Publication11-Nov-2014

Correspondence Address:
Harinatha Sreekar
Department of General Surgery, MVJ Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.144349

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  Abstract 

Liver abscess manifests with various clinical features. Features include vague abdominal pain, bowel disturbances, jaundice, and rarely abdominal swelling. The sheer plethora of the manifestations can confuse an unwary surgeon. Liver abscess manifesting with intestinal obstruction is rarely reported. This is one such case of liver abscess which manifested with intestinal obstruction which highlights a different mode of presentation of liver abscess.

Keywords: Abdominal distension, intestinal obstruction, liver abscess, ruptured liver abscess


How to cite this article:
Sudarshan P, Sinha A, Sreekar H, Arunchandra B. A case of ruptured liver abscess manifesting with intestinal obstruction . Arch Med Health Sci 2014;2:223-4

How to cite this URL:
Sudarshan P, Sinha A, Sreekar H, Arunchandra B. A case of ruptured liver abscess manifesting with intestinal obstruction . Arch Med Health Sci [serial online] 2014 [cited 2019 Oct 19];2:223-4. Available from: http://www.amhsjournal.org/text.asp?2014/2/2/223/144349


  Introduction Top


Liver abscesses are present with various clinical features. This potentially lethal disease has seen a paradigm shift in its management from open drainage to percutaneous drainage resulting in vastly better results with far less invasive procedures. The Achilles' heel of liver abscess management is the inability to diagnose the problem early. This is further complicated by the wide variety of manifestations with which it can present. Here, we present a case of ruptured liver abscess which presented with intestinal obstruction.


  Case Report Top


A 50-year-old gentleman presented with pain and distension of abdomen, and constipation for 4 days. He was a chronic alcoholic, tobacco smoker, and marijuana smoker. On examination, the patient was tachycardic and tachypneic. Abdominal examination revealed generalized distension, tenderness, and guarding. Fluid thrill and shifting dullness were present, and bowel sounds were absent. Abdominal paracentesis was done, and 5 ml of sero-sanguinous fluid was aspirated raising the suspicion of strangulation of the obstructed gut. Plain X-ray of the abdomen showed dilated bowel loops up to the descending colon with 2-3 fluid levels [Figure 1]. Abdominal ultrasonography revealed hepatomegaly with echogenic lesion in left and caudate lobe resembling an abscess, bilateral pleural effusion, dilated bowel loops and moderate ascites with internal echoes.
Figure 1: Plain X-ray showing dilated bowel loops and air-fluid levels

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Patient was resuscitated, and emergency laparotomy was performed. At laporotomy, 900 ml of anchovy sauce fluid was noted in the peritoneal cavity. The stomach, small intestine was normal without any evidence of perforartion. There were no adhesions between the liver and omentum. A ruptured liver abscess, about 3 cm × 2 cm in size was noted in the left lobe of the liver [Figure 2]. Thorough wash was given, and abdomen was closed after placing drains. The patient recovered uneventfully.
Figure 2: Hemoperitoneum with ruptured liver abscess

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  Discussion Top


Amoebic and pyogenic liver abscesses are common in tropical countries like India. With easy access to advanced imaging techniques, these are diagnosed fairly early if clinically suspected. The importance of clinical suspicion is thus paramount in managing liver abscess. Liver abscess have presented with varied features such as pleural empyema, [1] parietal wall abscess, [2] and endophthalmitis. [3] Liver abscess can also mimic pneumonia, acute pleurisy with effusion, empyema, chronic lung disease, pancreatic pseudocysts, malignancy, acute cholecystitis, perforated peptic ulcer, acute hepatitis, cirrhosis, hydatid cysts, tuberculosis, and pyrexia of unknown origin. [4] A clinician hence has to be aware of the various manifestations of liver abscess. Liver abscess rupture is rare and is more commonly reported with amoebic liver abscesses, at a rate of 5-20%. [5] A ruptured liver abscess make the matter more complicated due to its resemblance to intestinal obstruction in terms of bowel dilation and presence of guarding and rigidity. Studies have published a variety of clinical features associated with the liver abscess, including vomiting, abdominal tenderness, guarding, pain, etc. [6],[7] A higher rate of rupture is associated with Klebsiella-associated liver abscess. [8] Spontaneous rupture of Klebsiella-associated abscess was shown to be significantly associated with a larger abscess size, diabetes, gas formation and involvement of the left hepatic lobe. These features make accurate radiological investigation important in giving valuable clues regarding the presence of a liver abscess. The general complications include pleuro-pulmonary complications such as pleural effusion and atelectasis, amoebic peritonitis, which should be treated expediently.

Ruptured liver abscess hence presents with a conglomerate of symptoms and complications, which highlight the need of early diagnosis. What's more, important is perhaps the awareness among clinicians of its various manifestations, so that the treatment can be fast tracked.

 
  References Top

1.Chang HR, Lee JJ, Lin CB. Pleural empyema secondary to rupture of amoebic liver abscess. Intern Med 2012;51:471-4.  Back to cited text no. 1
    
2.Gupta G, Nijhawan S, Katiyar P, Mathur A. Primary tubercular liver abscess rupture leading to parietal wall abscess: A rare disease with a rare complication. J Postgrad Med 2011;57:350-2.  Back to cited text no. 2
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3.Chong VH, Zainal-Abidin Z, Hassan H, Chong CF. Rare complications of pyogenic liver abscess. Singapore Med J 2010;51:e169-72.  Back to cited text no. 3
    
4.Berne CJ. Diagnosis and treatment of amebic liver abscess. Surg Gynaecol Obstet 1942;75:235-7.  Back to cited text no. 4
    
5.Salles JM, Moraes LA, Salles MC. Hepatic amebiasis. Braz J Infect Dis 2003;7:96-110.  Back to cited text no. 5
    
6.Memon AS, Siddiqui FG, Memon HA, Ali SA. Management of ruptured amoebic liver abscess: 22-years experience. J Ayub Med Coll Abbottabad 2010;22:96-9.  Back to cited text no. 6
    
7.Lai YC, Su YJ, Chang WH. Ruptured hepatic abscess mimicking perforated viscus. Int J Infect Dis 2008;12:e95-7.  Back to cited text no. 7
    
8.Lee CH, Leu HS, Wu TS, Su LH, Liu JW. Risk factors for spontaneous rupture of liver abscess caused by Klebsiella pneumoniae. Diagn Microbiol Infect Dis 2005;52:79-84.  Back to cited text no. 8
    


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