The article describes the case of a young, previously healthy woman with a pyogenic liver abscess that ruptured spontaneously. The rupture resulted in a massive subcapsular hematoma of the liver. The sudden release of pus and bacterial toxins into the abdominal cavity triggered the rapid development of septic shock. Simultaneous damage to the large intrahepatic vessels also caused life-threatening hemorrhagic shock within hours. The patient underwent emergency laparoscopic surgery and was admitted to the intensive care unit. Follow-up examinations 1, 3 and 6 months after the operation did not show any unwanted complications. The authors report that this is the first published case of such a complicated ruptured liver abscess in a young immunocompetent woman.