# 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.

## Key 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.