This paper presents a case of ruptured amebic liver abscess with panperitonitis. A 33-year-old man was admitted to the hospital because of fever and sever pain of the entire abdomen. Laboratory tests revealed leucocytosis and liver dysfunction. Abdominal ultrasonography and an abdominal CT scan demonstrated two abscesses in the right lobe of the liver. The patient was diagnosed as having ruptured liver abscess with panperitonitis and underwent an emergency operation on the same day. Pus of an “anchovy sauce” appearance was obtained from the liver abscesses. Surgical drainage of the abscesses and peritoneal cavity, and an appendectomy were performed. Postoperatively the patient had a persistent fever. After administration of metronidazole, his condition recovered markedly. Entamoeba histolytica was not found in the pus of the abscesses, but found in the wall of appendix. Amebic liver abscess was finaly diagnosed based on the results of a serologic test.