Hepatic Abscess as a Rare Late Complication of Perforated Appendicitis. A Case Presentation.

Abstract

Background: Acute appendicitis is a common surgical emergency, predominantly affecting young males. Although laparoscopic appendectomy reduces adverse outcomes, potential complications related to this condition are known. Among these, hepatic abscess is a rare and severe complication, with limited cases reported in the literature. Case Report: We report a case of an 18-years-old male with diffuse purulent peritonitis due to perforated appendicitis who developed a hepatic abscess one month post-surgery. Despite the initial management including surgical intervention and antibiotic therapy, after one month the patient presented with high temperature and right upper quadrant pain, leading to the discovery and subsequent percutaneous drainage of a hepatic abscess and intravenous antibiotic therapy. The abscess culture identified Bacteroides Fragilis, guiding targeted antibiotic therapy and resulting in a full recovery. Discussion: This case highlights the potential for hepatic abscess formation following acute appendicitis, suspected to arise from hematogenous bacterial spread. Given the uncommon nature of this complication, a high index of suspicion in patients presenting with unusual symptoms post-appendectomy is required. Immediate percutaneous drainage alongside broad-spectrum antibiotic therapy, followed by targeted treatment upon pathogen identification, is crucial for managing this life-threatening condition. Conclusion: Although rare, hepatic abscess can occur as a complication of acute appendicitis, underscoring the importance of awareness and prompt intervention to prevent severe outcomes. Percutaneous drainage of the abscess associated to a targeted antibiotic therapy represents the treatment of choice.