Percutaneous treatment of an intrahepatic abscess caused by a penetrating duodenal ulcer

We present a well-documented case of duodenal ulcer that penetrated into the quadrate lobe of the liver with subsequent abscess and fistula formation. An accurate diagnosis depended on the use of ultrasound to identify the presence of an abnormal gas pattern in the liver which had been mistaken for bowel on computed tomography. Successful percutaneous drainage under ultrasound guidance was then accomplished. This is the first recorded case we can find in which percutaneous drainage combined with antibiotic and H2 blocker therapy was able to supplant the surgical treatment of liver abscess with an enteric fistula. The diagnosis and management of this condition are discussed. Special reference is made to the use of ultrasound to overcome a major pitfall in the use of computed tomography for diagnosing liver abscesses with fistula formation.