Spontaneous Hepatic Hemorrhage Caused by Emphysematous Cholecystitis: A Case Report and Literature Review.

BACKGROUND: Emphysematous cholecystitis and spontaneous hepatic hemorrhage are uncommon and serious conditions with non-specific presentations that can lead to a poor clinical outcome. We report a case of spontaneous hepatic hemorrhage of emphysematous cholecystitis. A 49-year-old male presented to the emergency department with fever, chills, right upper quadrant pain, vomiting, and diarrhea of four days' duration. He had a history of diabetes mellitus, hypertension, and uarthritis. Computed tomography (CT) revealed an enlarged gallbladder with intra-luminal, intra-mural, and peri-cholecystic air; subcapsular high-density fluid collection; and an intra-hepatic mass with gas and liquid in the right lobe of the liver. After receiving prompt administration of appropriate antibiotic agents, drainage, and an alternative operation the patient recovered well. CONCLUSION: Emphysematous cholecystitis is potentially fatal because of its serious complications. It needs to be diagnosed promptly, not only based on the effervescent gallbladder sign but also on the inflammatory presentations. Furthermore, for patients with spontaneous hepatic hemorrhage, attention should be paid to the underlying cause. Treatment should be individualized to improve diagnosis and cure as early as possible, thereby improving prognosis.

Pneumocardia and septic pulmonary embolism due to nongas-forming liver abscess: A case report.

RATIONALE: Pneumocardia and septic pulmonary embolism are uncommon complications of Klebsiella pneumoniae primary liver abscess (KPLA); however, they may lead to a poor clinical outcome. PATIENT CONCERNS: A 67-year-old woman was admitted to our hospital with fever, chills, cough, and dyspnea for 4 days. She had a previous history of diabetes mellitus. DIAGNOSES: The chest computed tomography (CT) revealed multiple peripheral nodules in both lungs and wedge-shaped peripheral infiltrative lesions abutting the pleura, suggestive of septic pulmonary embolism. An abdominal CT on the following day showed a large liver abscess without gas formation and pneumocardia of the right ventricle. INTERVENTIONS: After the antibiotic therapy of intravenous imipenem and drainage of the liver abscess, our patient made a complete recovery. OUTCOMES: The patient was discharged on the 25th hospital day after full recovery and was doing well on follow-up at 10 months. LESSONS: KPLA is potentially fatal due to the associated serious metastatic complications. Attention must be paid not only to the primary focus of infection but also to infection of other organs. It is important to detect to diagnose the spread of infection accurately, in a timely manner, to improve the prognosis of this condition.