Background: Most causative of liver abscess, in about 90% of all cases are pyogenic abscess. One of the rare and dangerous complications of pyogenic liver abscess (PLA) that requires urgent management, even with nonspecific signs and symptoms, is abscess rupture. Case Presentation: A 27-years-old male patient with continuous right upper abdominal pain since a week after the patient fell down the stairs and hit the right side of his stomach against the stairs. Abdominal ultrasound revealed heteroechoic lesion with ill borders, irregular margin, and internal moving echo (+) in the right lobe of the liver, which on color doppler examination showed minimal perilesional vascularization. The patient underwent abdominal computed tomography (CT) scan with contrast four days later with showed rim enhancing semisolid lesion (23-33 HU) with air density (-925 HU) within it in, in the segments V to VIII of the right lobe of the liver partially ruptured in the periphery of segments VI-VII of the liver lobe with pneumoperitoneum and ascites. A week later a laparotomy was performed and the culture of the pus specimen revealed a growth of Escherichia coli. Conclusion: Based on clinical symptoms and imaging, PLA is not without any challenges in diagnosis. The key to avoid misdiagnosis of ruptured PLA are meticulous examination of the clinical and imaging also vigilant monitoring.

Liver abscess

Abdominal ultrasound

Abdominal ct scan

rupture