Case Report: Massive subcapsular hepatic hematoma after spontaneous rupture of pyogenic liver abscess in a healthy young woman

TL;DR

A healthy young woman experienced a rare and life-threatening rupture of a liver abscess, leading to severe bleeding and infection requiring emergency surgery.

Contribution

This is the first reported case of a ruptured pyogenic liver abscess complicated by massive subcapsular hematoma in a young immunocompetent woman.

Findings

A healthy young woman developed hemorrhagic and septic shock from a ruptured liver abscess.

Emergency laparoscopic surgery and ICU care successfully treated the condition with no long-term complications.

The case highlights the need for early recognition and multidisciplinary management of such rare but severe events.

Abstract

Bacterial and parasitic agents can cause liver abscess (LA), and spontaneous rupture of a pyogenic liver abscess (PLA) represents an exceedingly rare but life-threatening event. Upon abscess rupture, a sudden influx of pus and bacterial toxins into the peritoneal cavity can trigger a dysregulated host response to infection. Should major intrahepatic vessels be involved, life-threatening hemorrhagic shock may supervene, with clinical deterioration occurring within hours. We present the first case of a young woman with a ruptured liver abscess complicated by a massive subcapsular hematoma who rapidly developed hemorrhagic and septic shock and underwent emergency laparoscopic surgery followed by intensive care unit (ICU) admission. No adverse complications were observed in follow-ups at one, three, and six months after the operation. This case emphasizes that even immunocompetent young adults can experience acute abscess rupture with life-threatening hemorrhagic shock, mandating early recognition, prompt intervention, and multidisciplinary management.

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