Pyogenic liver abscess following perforated appendicitis

A 26-year-old male patient presented to the emergency department with abdominal pain, fever, weakness, and loss of appetite, which he had been experiencing for approximately four days. Laboratory studies revealed leukocytosis (19 × 103 µL) and an elevated C-reactive protein level (328 mg/L). Computed tomography (CT) showed a subcapsular abscess in the right hepatic lobe (Figure 1). We observed that the appendix was attached to the liver capsule and opened to the liver with a fistula (Figure 2). Ultrasound-guided percutaneous drainage of the subcapsular liver abscess was performed. Following antibiotic treatment, the patient was discharged for outpatient follow-up and considered for an appendectomy.

FIGURE 1:
CT shows right hepatic lobe subcapsular abscess (arrowheads).

FIGURE 2:
Acute appendicitis (arrow) can be observed.

Pyogenic liver abscess is extremely rare. It can lead to death if left untreated¹. Following the diagnosis, appropriate treatment should be applied with great care, pylephlebitis should be kept in mind, and portal vein involvement should be considered in imaging².

ACKNOWLEDGMENTS

The author has no acknowledgments.

REFERENCES

• ¹
  Armstrong T, Dluzewski S, Yu D. Appendicitis with direct fistulation into the liver: A forgotten cause of pyogenic liver abscess. BJR Case Reports. 2020;6(4):20200101.
• ²
  Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): Diagnosis and management in the modern era. Clin Infect Dis. 1995;21(5):1114-20. Available from: https://doi.org/10.1093/clinids/21.5.1114. PMID: 8589130.
  » https://doi.org/10.1093/clinids/21.5.1114

• Financial Support: The author declares that no grants or funds were received.

Publication Dates

• Publication in this collection
  30 Sept 2022
• Date of issue
  2022

History

• Received
  15 May 2022
• Accepted
  24 Aug 2022