Anterior abdominal wall abscess secondary to spontaneous rupture of liver abscess in a resource-limited, rural, surgical setting: A case report

Royson Dsouza,Manbha Rymbai,Dr Harshad Arvind Vanjare,Dr Mrudula Rao

doi:10.15566/cjgh.v8i1.507

Abstract

Liver abscess continues to be a major surgical burden in low and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic lady with a past history of laparoscopic cholecystectomy presented with acute pain in the right upper quadrant. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with USG guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited rural surgical centers. The patient’s clinical presentation, investigations, and management have been discussed with a relevant review of the literature.

Highlights

Liver abscess is one of the oldest surgical emergencies, described from the time of Hippocrates.[1]
We present a 53-yearold female who was diagnosed with a liver abscess which had ruptured into the anterior abdominal wall and was successfully managed with the available resources in a rural tribal health care facility
There are no recent national or regional epidemiological studies to determine the prevalence of liver abscess in India, rural patients share a fair burden.[4,6]

Summary

Introduction

Liver abscess is one of the oldest surgical emergencies, described from the time of Hippocrates.[1] Of the complications associated with it, rupture into the anterior abdominal wall is an unusual event and can lead to increased morbidity and mortality.[2,3] Much has evolved in their management with lesser invasive procedures being the standard of care. Liver abscess, which was primarily a surgical condition, is being managed by interventional radiologists. In a resource-limited, rural, surgical setting, most facilities are not properly equipped or available. Management of the patient still remains in the hands of a surgeon

Results

Discussion

Conclusion