Pyogenic Abscess Liver Secondary to Perforated Appendicitis

Abstract

BACKGROUND: Pyogenic liver abscess (PLA) secondary to perforated appendicitis can be potentially life-threatening. However, the mortality of PLA has decreased due to earlier and improved diagnosis, development of intensive care, and progression of minimally invasive treatment. Here we present a patient with a pyogenic liver abscess formed after appendectomy.

CASE REPORT: A 40-year-old man complained of abdominal pain in the right upper quadrant for the last month. Examination of his abdomen showed enlarged liver, approximately 3 fingers below costae. Laboratory results showed an increased white blood count of 14.000 /mL and slight hypoalbuminemia of 2.9 g/dL. An ultrasound showed liver abscess. The abdominal CT revealed a 6,78 cm x 6,18 cm x 5,4 cm lobulated hypodense cystic mass. The patient was treated with 3rd generation Cephalosporin and underwent percutaneous drainage with Escherichia coli growth on the culture result. The patient was discharged on the 8th day after admission with significant improvement dan there are no other complications.

CONCLUSION: Early diagnosis and prompt treatment can lead to a better prognosis. Antibiotic is recommended in early treatment to lower bacterial load and control the symptoms of systemic infections. However, effective drainage is recognized as the most effective treatment for large liver abscess, since it could lower bacterial load and increase antibiotic penetration into the abscess.