SUMMARY
Liver abscess continues to be a major surgical burden in low and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic lady with a past history of laparoscopic cholecystectomy presented with acute pain in the right upper quadrant. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with USG guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited rural surgical centers. The patient’s clinical presentation, investigations, and management have been discussed with a relevant review of the literature.