title: Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess.
abstract: BACKGROUND
  Pyogenic liver abscess is a rare cause of hospitalization, related to a mortality rate ranging between 15% and 19%. Treatment of choice is represented by image-guided percutaneous drainage in combination with antibiotic therapy but, in some selected cases, surgical treatment is necessary. In extremely rare cases, spontaneous rupture of liver abscess may occur, free in the peritoneal cavity or in neighboring organs, an event which is generally considered a surgical emergency.
  
  
  METHODS
  A 95-years-old woman was hospitalized with fever, upper abdominal pain, mild dyspepsia and massive swelling of the anterior abdominal wall. Computed tomography revealed an oval mass located in the abdominal wall of 12cm×14cm×7cm, in continuity with an abscess of the left hepatic lobe. Because Proteus mirabilis was detected in both the liver abscess and the abdominal wall abscess, the patient was diagnosed with a ruptured pyogenic liver abscess. After spontaneous drainage to the exterior of the hepato-parietal abscess, she was successfully treated with antibiotics alone.
  
  
  CONCLUSIONS
  Pyogenic liver abscess is a serious and life-threatening illness. Abscess rupture might occur. Many authors consider this complication a surgical emergency, but the site of abscess rupture changes the clinical history of the disease: in case of free rupture into the peritoneum, emergency surgery is mandatory, while a rupture localized in neighboring tissues or organs can be successfully treated by a combination of systemic antibiotics and fine needle aspiration and/or percutaneous drainage of the abscess.
authors.affiliation: Department of General Surgery, C.S. Surgical Oncology and Reconstructive Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: zizzomaurizio@gmail.com.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zizzo
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: Claudia.Zaghi@asmn.re.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Zaghi
authors.affiliation: Department of General Surgery, Azienda Ospedaliero - Universitaria Policlinico di Modena, Del Pozzo Street 71, 41124 Modena, Italy. Electronic address: antonio.manenti@unimore.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Manenti
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: Davide.Luppi@asmn.re.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Luppi
authors.affiliation: Department of General Surgery, C.S. Surgical Oncology and Reconstructive Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: gigiodoctorchir@gmail.com.
authors.forename: Lara
authors.initials: L
authors.lastname: Ugoletti
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: Stefano.Bonilauri@asmn.re.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonilauri
keywords: Abdominal wall abscess; Proteus mirabilis; Pyogenic liver abscess; Spontaneous rupture