Abstract

Liver abscess is a common condition in tropical countries and is associated with significant morbidity and mortality. Traditionally, there are two major classifications of hepatic abscess; pyogenic and amoebic. There are various complications associated with hepatic abscesses, of which, rupture of the abscess is the most common. Intraperitoneal rupture of liver abscess is a rare but potentially fatal disease. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. Improving imaging techniques have aided the CLInicians in the diagnosis of hepatic abscesses and have subsequently become important treatment tools, the demographics of the hepatic abscess have changed. Though open surgery still remains most commonly used management modality, with advent of minimally invasive surgery. Thus, multiple management options are available today and ruptured liver abscess is a preventable and manageable. No specific guidelines are available for choosing the modality of treatment. Thus, this article purpose is to report a case of a patient that presented with acute abdomen at the emergency caused by a rupture liver abscess. A 7 year old male child presented to the Emergency Department due to severe abdominal pain during the last 7 days. The pain was located in the RHC, associated with constipation and three to four episodes of vomiting. On physical examination, generalized abdominal tenderness was present without any guarding or rigidity and no abdominal lump palpable. There were no signs of peritonitis. Blood tests including complete blood count, serum electrolytes, bilirubin, and liver and kidney function tests were performed which were unremarkable and showed no other abnormalities. Prothrombin time, partial thromboplastin time and INR (International Normalized Ratio) were normal. In our case in diagnostic laparoscopy after initial abdomen exploration around 200cc purulent fluid filled peritoneal cavity noted and ruptured liver abscess diagnosis confirmed so diagnostic laparoscopy converted to exploratory laparotomy. Peritoneal lavage given with approx 1500cc warm saline.and metronidazole wash is also given.after clearing all toxic fluid and. All abdominal organs examined and layer wise closing done. The total operative time was 120 minutes and our patient’s post-operative period was unevetful. He was discharged on the seven post-operative day.

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