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

  • Royson Dsouza Ashwini, Gudalur Adivasi Hospital
  • Dr. Mrudula Rao Ashwini, Gudalur Adivasi Hospital
  • Dr. Harshad Arvind Vanjare Christian Medical College Hospital Vellore https://orcid.org/0000-0002-4321-7221
  • Manbha Rymbai Christian Medical College and Hospital, Vellore
Keywords: Liver abscess, minimally invasive surgery, limited-resource settings, percutaneous drainage, Spontaneous rupture

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.  

Author Biographies

Royson Dsouza, Ashwini, Gudalur Adivasi Hospital

MBBS, MS, Consultant Surgeon, Ashwini Gudalur Adivasi Hospital, The Nilgiris, Tamil Nadu, India

Dr. Mrudula Rao, Ashwini, Gudalur Adivasi Hospital

MBBS, PGDFM

Dr. Harshad Arvind Vanjare, Christian Medical College Hospital Vellore

MBBS, MD, Associate Professor, Department of Radiology, Christian Medical College and hospital Vellore, India

Manbha Rymbai, Christian Medical College and Hospital, Vellore

MBBS, MS, MCH, Department of Hepatobiliary Surgery, Christian Medical College and Hospital, Vellore, India

References

Papavramidou N, Samara A, Christopoulou-Aletra H. Liver abscess in ancient Greek and Greco-Roman texts. Acta Medico-Hist Adriat AMHA. 2014;12(2):321–8.

Zizzo M, Zaghi C, Manenti A, Luppi D, Ugoletti L, Bonilauri S. Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess. Int J Surg Case Rep. 2016;25:110. http://doi.org/10.1016/j.ijscr.2016.06.026

Chong VH, Zainal-Abidin Z, Hassan H, Chong CF. Rare complications of pyogenic liver abscess. Singapore Med J. 2010 Oct;51(10):e169-172.

Reddy P, Ashwin K, Srinivasan N, Halbhavi MR. A study of treatment outcomes of liver abscess in a rural tertiary care centre. Int Surg J. 2019 Jun 29;6(7):2439–43. http://doi.org//10.18203/2349-2902.isj20192970

Manza J, Makwana H, Pancholi M, Verma N. Study of different modalities of management in patients with liver abscess in a tertiary care centre. 2018;6(1):5. http://doi.org/10.17354/liss/2018/115

Rickard J, Beilman G, Forrester J, Sawyer R, Stephen A, Weiser TG, et al. Surgical Infections in low- and middle-income countries: a global assessment of the burden and management needs. Surg Infect. 2019 Dec 9;21(6):478–94. http://doi.org/10.1089/sur.2019.142

Holzheimer RG, Mannick JA, editors. Surgical treatment: evidence-based and problem-oriented. Munich: Zuckschwerdt; 2001. PMID: 21028753.

Donovan AJ, Yellin AE, Ralls PW. Hepatic abscess. World J Surg. 1991 Apr;15(2):162–9. https://doi.org/10.1007/BF01659049

Runge VM, Wells JW, Williams NM. Hepatic abscesses. Magnetic resonance imaging findings using gadolinium-BOPTA. Invest Radiol. 1996 Dec;31(12):781–8. https://doi.org/10.1097/00004424-199612000-00008

Kathel P, Mudgal MM, Kushwah N. Comparison of various techniques used in the management of liver abscess [Internet]. :5. Available from: https://www.semanticscholar.org/paper/Comparison-of-Various-Techniques-Used-in-The-of-Kathel-Mudgal/4e6a87ea91feb36b0f6ac9f1f38ad8ba4de4e732

Pitt HA. Surgical management of hepatic abscesses. World J Surg. 1990 Aug;14(4):498–504. https://doi.org/10.1007/BF01658675

Alkofer B, Dufay C, Parienti JJ, Lepennec V, Dargere S, Chiche L. Are pyogenic liver abscesses still a surgical concern? A Western experience [Internet]. Vol. 2012, HPB Surgery. Hindawi; 2012 [cited 2021 Jan 22]. p. e316013. Available from: https://downloads.hindawi.com/archive/2012/316013.pdf

Satish Kumar R, Madhushankar L, Nataraj Naidu R, Ramalingeshwara K, Laxmikantha L, Amit Gupta M, et al. Treatment strategies in liver abscess our experience. J Evol Med Dental Sci. 2013 Nov 11;2(45):8768-75. https://doi.org/10.14260/jemds/1522

Cai Y, Xiong X, Lu J, Cheng Y, Yang C, Lin Y, et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: a systematic review and meta-analysis. HPB. 2014 Oct 1;17. https://doi.org/10.1111/hpb.12332

Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PLOS ONE. 2019 Feb 7;14(2):e0211984. https://doi.org/10.1371/journal.pone.0211984

G S Rozycki. Surgeon-performed ultrasound: its use in clinical practice. Ann Surg. 1998 Jul;228(1):16-28. https://doi.org/10.1097/00000658-199807000-00004

Chung Hwan Jun, Jae Hyun Yoon, Jin Woo Wi, Seon Young Park, Lee WS, Jung SI,et al. Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess. J Dig Dis. 2015 Jan; 16(1): 31-6. http://doi.org/10.1111/1751-2980.12209

Motoyama T, Ogasawara S, Chiba T, Suzuki E, Yokota H, Haga Y, et al. Successful non-surgical treatment of ruptured pyogenic liver abscess. Intern Med Tokyo Jpn. 2013;52(23):2619–22. https://doi.org/10.2169/internalmedicine.52.0980

Kawoosa NU, Bashir A, Rashid B. Spontaneous cutaneous rupture of a pyogenic liver abscess. Indian J Surg. 2010 Aug;72(4):339–42. https://doi.org/10.1007/s12262-010-0131-3

Belabbes S. Anterior abdominal wall abscess revealing a pyogenic liver abscess: a case report. Research 2014;1:1256. http://doi.org/10.13070/rs.en.1.1256

Ndong A, Tendeng J, Ndoye N, Dieye A, Diallo A, ElMansouri M, et al. Liver abscess ruptured in the abdominal wall: a rare complication in a child. Surg Chron. 2019 Sep 1;24:162–3.

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 Oct 1;57(4):350. https://doi.org/10.4103/0022-3859.90095

Published
2021-07-30
How to Cite
Dsouza, R., Rao, D. M., Vanjare, D. H. A., & Rymbai, M. (2021). Anterior abdominal wall abscess secondary to spontaneous rupture of liver abscess in a resource-limited, rural, surgical setting: A case report. Christian Journal for Global Health, 8(1), 72-77. https://doi.org/10.15566/cjgh.v8i1.507