Pyogenic Liver Abscess Following Incision and Drainage of a Perianal Abscess: A Case Report

Abstract

Introduction: Perianal abscess represents a prevalent condition in colorectal surgical practice, characterized by significant morbidity and limited efficacy of conservative management. While incision and drainage (I&D) remain the gold standard therapeutic approach, the subsequent development of hepatic abscess (HA) constitutes an exceptionally rare complication. Pyogenic liver abscesses, predominantly of bacterial etiology (with parasitic and fungal origins being considerably less common), carry substantial mortality risks approaching 15%, particularly in immunocompromised hosts or those with compromised nutritional status. This report describes an unusual case of multiple pyogenic liver abscesses developing in a young, immunocompetent adult following routine I&D of a perianal abscess, highlighting the importance of recognizing this potential sequela. Case Presentation: Diagnostic confirmation was achieved through comprehensive clinical assessment [persistent fever, right upper quadrant (RUQ) tenderness], laboratory evaluation (marked leukocytosis, elevated transaminases), and radiologic confirmation via contrast-enhanced abdominal CT demonstrating multiple hypodense hepatic lesions. Microbiological analysis of pre-treatment blood cultures yielded Staphylococcus epidermidis and Streptococcus pharyngitis. The therapeutic regimen comprised initial empiric intravenous ampicillin-sulbactam, subsequently de-escalated to oral levofloxacin based on antimicrobial susceptibility profiles, supplemented with polyene phosphatidylcholine for hepatic protection. We document the successful management of multifocal pyogenic liver abscesses complicating perianal abscess drainage. The case illustrates the characteristic clinical trajectory from localized perianal infection to systemic dissemination with hepatic involvement, confirmed through serial imaging and microbiological studies. Conclusions: This case underscores the importance of vigilant postoperative monitoring following perianal procedures, particularly when persistent fever develops. The favorable outcome achieved through timely antibiotic therapy and supportive measures emphasizes the effectiveness of prompt recognition and appropriate management of this rare complication. The report contributes to the limited literature on hematogenous spread from anorectal infections to the hepatic parenchyma in immunocompetent hosts.