Ojuka Andrew, Lesetedi Chiapo, Jabo Christian, Mompati Kgosidialwa Frederick
Riverside Hospital, Francistown, Botswana.
Bokamoso Private Hospital, Gaborone, Botswana.
Pan Afr Med J. 2023 Dec 18;46:107. doi: 10.11604/pamj.2023.46.107.42256. eCollection 2023.
We report a case of gas-forming pyogenic liver abscess (GFPLA) with a ruptured abscess and biliary fistula presenting with peritonitis. The patient had poorly controlled diabetes mellitus and was extremely ill at presentation. The diagnosis was delayed until the abscess ruptured, owing to nonspecific abdominal symptoms at the initial presentation and delayed follow-up radiological investigations. The patient had a high-output biliary fistula post-operatively, which was managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting with fistula drainage reduction within four weeks. This case highlights the need for follow-up radiological investigations and prompt intervention in patients with diabetes mellitus presenting with fever and vague abdominal pain.
我们报告一例产气性化脓性肝脓肿（GFPLA），脓肿破裂并伴有胆瘘，表现为腹膜炎。该患者糖尿病控制不佳，就诊时病情极为严重。由于初次就诊时腹部症状不具特异性且后续影像学检查延迟，诊断延误至脓肿破裂。患者术后出现高流量胆瘘，通过内镜逆行胰胆管造影（ERCP）及支架置入术在四周内减少了瘘管引流，从而得以控制。该病例强调了对出现发热和腹部隐痛的糖尿病患者进行后续影像学检查及及时干预的必要性。
