Hepatogastric fistula in a pediatric patient

Double Trouble: Synchronous Hepatoduodenal and Hepatocolic Fistulisation in a Case of Untreated Liver Abscess

A hepatic abscess is a potentially life-threatening condition that can lead to major complications if left untreated. One of the rarest complications of hepatic abscesses is rupture into adjacent organs like the duodenum, stomach, and colon. We report a case of an elderly male patient with a hepatic abscess that ruptured into the duodenum and colon, forming fistulous connections. To the best of our knowledge, this is the only reported case of hepatic abscess with simultaneous hepatoduodenal and hepatotoxic fistulas, confirmed radiologically and endoscopically. This report signifies the need for a high level of vigilance for extremely rare complications in relatively common conditions.

Hepatogastric fistula: a rare complication of pyogenic liver abscess

Hepatogastric fistula is very rare. We report a case of hepatogastric fistula as a complication of pyogenic liver abscess. A 40-year-old man presented with upper abdominal pain and high-grade fever of 2 weeks. Evaluation revealed multiple liver abscesses. On an empirical diagnosis of pyogenic liver abscess, he was treated with antibiotics. During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. As expectant management failed to resolve the abscess, endoscopic retrograde papillotomy and stenting of common bile duct was performed. After endoscopic stenting, symptoms subsided. Imaging repeated after 2 weeks of endoscopic stenting showed resolving abscess. He was discharged and is doing well on regular follow-ups. We conclude that hepatogastric fistula can be managed by endoscopic stenting as bile flow through the stent hastens resolution and healing of the fistula.

Delayed spontaneous hepatogastric fistula formation following transcatheter arterial embolisation and radiotherapy for hepatocellular carcinoma

A 58-year-old male patient with an unresectable 10 cm liver lesion that was a histologically proven hepatocellular carcinoma (HCC) underwent transcatheter hepatic artery embolisation (TAE). 4 months later, the patient was referred for salvage radiotherapy owing to local recurrence. The HCC became an encapsulated tumour with central necrosis after radiotherapy. The patient enjoyed a normal lifestyle for 9 years, with local control achieved by radiotherapy, until a hepatogastric fistula developed. Although the hepatogastric fistula resolved with surgical drainage, the patient later died from septic shock. Hepatogastric fistula is a rare but serious complication after TAE and radiotherapy for HCC. Development of fever, abdominal pain and jaundice after an initial symptom-free interval should arouse suspicion of hepatogastric fistula formation from an encapsulated necrotic HCC or a ruptured liver abscess. Because the mortality is high, aspiration of a suspected necrotic lesion should be performed as soon as possible. Patients with risk factors, including liver cirrhosis and large lesions close to the adjacent gastrointestinal tract, are especially vulnerable. Gas formation within a necrotic liver tumour requires immediate drainage.