title: A liver abscess presenting as bowel obstruction and perforation.
abstract: A 69-year-old cachexic man presented with tachycardia and hypotension on a background of 7 days of vomiting and constipation. He was not obviously in pain. He had a raised white cell count of 24.8×10(9)/l, and a lactate of 2.2 mmol/l. A chest x-ray had the appearance of free air under the diaphragm and he was suspected of having a bowel obstruction with perforation. An abdominal CT scan showed instead a large fluid and gas-filled hepatic abscess, and a second smaller simple cyst. The abscess was percutaneously drained, and the purulent fluid drained grew Streptococcus milleri. The patient was discharged home 2 weeks later.
authors.affiliation: Accident and Emergency Department, Chelsea Westminster Hospital, London, UK. jan_rusman@yahoo.com
authors.forename: Jan
authors.initials: J
authors.lastname: Rusman
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004322:Drainage; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000382:microbiology*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000382:microbiology*; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy*; D008297:Male; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy*; D034364:Streptococcus milleri Group / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed