{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T07:23:54Z","timestamp":1762327434909,"version":"build-2065373602"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pyogenic liver abscess (PLA) is a severe condition with mortality rates of 10%\u201319%. Spontaneous rupture occurs in about 5% of cases and carries much higher mortality. Rarely, ruptured PLA presents with pneumoperitoneum, mimicking hollow viscus perforation. We report a 48-year-old man with chronic gastric ulcer disease who presented with fever, malaise, nausea, and abdominal distension two weeks after endoscopic hemostasis. He rapidly deteriorated with septic shock and peritoneal signs. Ultrasound was inconclusive, and repeat X-ray revealed pneumoperitoneum. Laparotomy found purulent peritonitis from a subcapsular abscess in segment II, perforating both diaphragmatic and visceral hepatic surfaces. Enterococcus faecalis was isolated, and antibiotics administered. A secondary abscess in segment VII was later drained percutaneously. The patient recovered after 37\u00a0days. This case highlights the diagnostic challenge of ruptured PLA and the value of combined surgical and minimally invasive management.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf867","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T12:16:24Z","timestamp":1760616984000},"source":"Crossref","is-referenced-by-count":0,"title":["When free air misleads: pneumoperitoneum from a ruptured pyogenic liver abscess"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4005-5570","authenticated-orcid":false,"given":"Yavor","family":"Asenov","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8621-0046","authenticated-orcid":false,"given":"Boris","family":"Kunev","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todor","family":"Yanev","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Branimir","family":"Golemanov","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Plamen","family":"Getsov","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolay","family":"Penkov","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital \u201cTsaritsa Yoanna\u2013ISUL\u201d, Medical University\u2013Sofia , 1527 Sofia ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2025110501251614000_ref1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1002\/cld.1128","article-title":"Liver abscess: complications and treatment","volume":"18","author":"Sharma","year":"2021","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"2025110501251614000_ref2","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s13756-019-0615-2","article-title":"Clinical, microbiological, and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess","volume":"8","author":"Zhang","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"2025110501251614000_ref3","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1111\/1751-2980.12209","article-title":"Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess","volume":"16","author":"Jun","year":"2015","journal-title":"J Dig Dis"},{"key":"2025110501251614000_ref4","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1111\/j.1572-0241.1995.tb09316.x","article-title":"Rupture of pyogenic liver abscess","volume":"90","author":"Chou","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"2025110501251614000_ref5","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1186\/s12893-020-00858-w","article-title":"Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report","volume":"20","author":"Pham Van","year":"2020","journal-title":"BMC Surg"},{"key":"2025110501251614000_ref6","doi-asserted-by":"publisher","first-page":"7922","DOI":"10.1038\/s41598-023-34889-z","article-title":"Diabetes and obesity and risk of pyogenic liver abscess","volume":"13","author":"Wang","year":"2023","journal-title":"Sci Rep"},{"key":"2025110501251614000_ref7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s10096-022-04543-z","article-title":"Enterococcal pyogenic liver abscesses: high risk of treatment failure and mortality","volume":"42","author":"Oliosi","year":"2023","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025110501251614000_ref8","first-page":"139","article-title":"Gas-containing epidural abscess caused by Enterococcus faecalis","volume":"12","author":"Park","year":"2015","journal-title":"Neurospine"},{"key":"2025110501251614000_ref9","doi-asserted-by":"publisher","first-page":"e95","DOI":"10.1016\/j.ijid.2008.06.005","article-title":"Ruptured hepatic abscess mimicking perforated viscus","volume":"12","author":"Lai","year":"2008","journal-title":"Int J Infect Dis"},{"key":"2025110501251614000_ref10","doi-asserted-by":"publisher","first-page":"2619","DOI":"10.2169\/internalmedicine.52.0980","article-title":"Successful non-surgical treatment of ruptured pyogenic liver abscess","volume":"52","author":"Motoyama","year":"2013","journal-title":"Intern Med"},{"key":"2025110501251614000_ref11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4166\/kjg.2018.71.1.45","article-title":"Ruptured gas-forming pyogenic liver abscess into the peritoneal cavity treated successfully with medical treatment","volume":"71","author":"Lee","year":"2018","journal-title":"Korean J Gastroenterol"},{"key":"2025110501251614000_ref12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.21315\/mjms2022.29.5.7","article-title":"Aging is associated with prolonged hospitalisation stay in pyogenic liver abscess","volume":"29","author":"Chan","year":"2022","journal-title":"Malays J Med Sci"},{"key":"2025110501251614000_ref13","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.ijscr.2016.06.026","article-title":"Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess","volume":"25","author":"Zizzo","year":"2016","journal-title":"Int J Surg Case Rep"},{"key":"2025110501251614000_ref14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2214\/AJR.16.17713","article-title":"Liver abscesses: factors that influence outcome of percutaneous drainage","volume":"209","author":"Haider","year":"2017","journal-title":"AJR Am J Roentgenol"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf867\/65173317\/rjaf867.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf867\/65173317\/rjaf867.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:25:27Z","timestamp":1762323927000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf867\/8313974"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf867","relation":{},"ISSN":["2042-8812"],"issn-type":[{"type":"electronic","value":"2042-8812"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,11]]},"article-number":"rjaf867"}}