Subcutaneous rupture of liver abscess
Elderly female presented with anorexia, malaise, fever, pain upper abdomen, non bilious vomiting, and yellowish discolouration of eyes since 20 days duration. o/e- gross pallor, icterus, sweating, dehydration. An ill defined lump was present in the right upper quadrant. Right upper abdomen was tender on palpation. Minimum rebound tenderness was also noted in the right upper abdomen. Skin overlying the right upper quadrant was erythematous and firm.
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Large ill defined peripherally enhancing collection is noted arising from segment IV B of left lobe of liver, also involving segment V and VI. The exophytic component of the lesion is tracking along the lateral wall of abdomen and extending across the muscle wall to the subcutaneous fat planes.
Fat stranding is seen in perilesional fat planes as well as subcutaneous fat planes.
There is mild ascites.
Percutaneous drainage of the abscess was done and sample was sent for culture and sensitivity. Culture report confirms polymicrobial infection with E.coli and Klebsiella pneumonea to be main causative agents.
Spontaneous rupture of a pyogenic liver abscess is a rare entity reported. The condition is rare and serious because of the possible delay in diagnosis.