Pyogenic liver abscess typically occurs secondary to biliary or haematogenous spread of organisms. In the context of acute appendicitis, abscesses generally occur due to haematogenous spread through the mesenteric vasculature. Historically, few cases of direct intra-abdominal spread have been reported but this has become vanishingly rare since the development of antibiotic therapy with no recorded cases in a search of over 900 cases in the literature.