Pyogenic liver abscess is a serious problem with significant morbidity. Most common causes are iatrogenic and ascending billiary infections. We present interesting case of 16 years old male with a pyogenic liver abscess leading to diaphragm perforation due to foreign body lodged in jejunum. Initially the patient was misdiagnosed as pneumonia by physician, referred to surgery opd for further evaluation. On subsequent return to opd for pain right hypochondrium, generalized abdomen pain and high grade fever and cough. During the examination of the patient erect x-ray abdomen showed nail in small gut, CT scan showed liver abscess but also inflammatory mass in RIF, nail lodged in it. Patient was not giving any history of nail ingestion. This kind of case has not been reported earlier.Keywords:
Hepatic abscess, pleural effusion, diaphragm perforation.