Two Cases of Panperitonitis Due to Intraperitoneal Rupture of Gas-Containing Pyogenic Liver Abscesses

Katsunori Imai, Toru Beppu, Hiromitsu Hayashi, Toshiro Masuda, Takao Mizumoto, Takatoshi Ishiko, Masahiko Hirota, Hideki Tanaka¹⁾, Yoshihiro Yoshimura²⁾ and Hideo Baba

Department of Gastroenterological Surgery and Department of Gastroenterology and Hepatology¹⁾, Graduate School of Medical Sciences, Kumamoto University
Department of Surgery, Kumamoto Chuo Hospital²⁾

We reported two rare cases of intraperitoneal rupture of gas-containing pyogenic liver abscesses. Case 1: A 52-year-old man admitted with a high fever and abdominal pain and diagnosed with panperitonitis showed marked tenderness and muscle defense in the entire abdomen on admission. Abdominal computed tomography (CT) indicated a gas-containing liver abscess, ascites, and free air in the abdominal cavity. Laboratory data indicated severe diabetes mellitus with BS of 544 mg/dl and HbA1c of 11.3%. We conducted emergency drainage under laparotomy. Klebsiella pneumoniae was detected from the abscess fluid. Case 2: A 65-year-old man who had undergone stenting for common bile duct stenosis due to advanced pancreatic cancer and admitted with a high fever and abdominal pain showed abdominal irritation. Abdominal CT showed gas-containing liver abscesses, ascites, and free air in the abdominal cavity. He was diagnosed with panperitonitis due to rupture of the liver abscess, necessitating emergency drainage under laparotomy. Lactococcus species was detected from the abscess fluid. The postoperative course of both men was uneventful and their liver abscesses gradually diminished.

Key words
gas-containing liver abscess, rupture of liver abscess, free air

Reprint requests
Katsunori Imai Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
1-1-1 Honjo, Kumamoto, 860-8556 JAPAN

Accepted
September 27, 2006

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