Pyogenic liver abscess presenting after malignant polypectomy

Pyogenic Liver Abscess or Liver Cyst Infection after Colonoscopic Polypectomy

A pyogenic liver abscess (PLA) mostly occurs in association with biliary tract disease, but some PLAs have no apparent underlying cause, i.e., they are cryptogenic. The authors experienced three cases of PLA or liver cyst infection after colon polypectomy without other distinct etiologies. These cases suggest that colonoscopic polypectomy can cause a mucosal defect that provides a route for bacteria to invade the portal system or spread intraperitoneally to the liver. Colonoscopic polypectomy should be considered as a procedure that might cause PLA. Moreover, clinicians should be aware of this possibility if a patient complains of fever or abdominal pain after a colonoscopic polypectomy.

Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer

Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4-cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.

Liver Cyst Infection after Colon Endoscopic Mucosal Resection in a Patient with Autosomal Dominant Polycystic Kidney Disease on Maintenance Hemodialysis

A 60-year-old Japanese man with autosomal dominant polycystic kidney disease (ADPKD) on maintenance hemodialysis underwent colonoscopy and endoscopic mucosal resection (EMR). He was hospitalized after 4 days of fever that began the day following colonoscopy. We detected Klebsiella pneumoniae in a blood culture and a ring-shaped integration in the liver cyst by gallium scintigraphy. He recovered with antibiotics and percutaneous drainage. The patient was believed to have contracted the liver cyst infection via an injured colonic mucosa and portal vein. Thus, if a patient exhibits fever after a colon EMR, for patients with ADPKD, then a liver cyst infection should also be considered in the differential diagnosis.

Pylephlebitis After Colonic Polypectomy Causing Fever and Abdominal Pain

Pylephlebitis is a rare condition with a high mortality risk if not recognized and treated early. The most common symptoms include fever and abdominal pain, with the majority of cases manifesting with a polymicrobial bacteremia. We report an elderly woman with pylephlebitis presenting with fever, abdominal pain, diarrhea, and vomiting, likely secondary to a polypectomy 6 weeks prior. Abdominal CT revealed portal vein thrombus and blood cultures grew Streptococcus milleri and Haemophilus parainfluenza type V. Pylephlebitis should be considered when symptoms and signs of infection develop following endoscopic procedures, particularly in patients with an underlying hypercoaguable disease.

Streptococcus anginosus pyogenic liver abscess following a screening colonoscopy

A previously healthy 58-year-old man presented with a septic thrombosis of the right hepatic vein and a pyogenic liver abscess (PLA) one week after undergoing a screening colonoscopy. Blood cultures and a radiological drainage specimen were both positive for Streptococcus anginosus. Evolution was favourable after six weeks of antibiotherapy. To the authors' knowledge, the present report is the first to describe a PLA following a screening colonoscopy with no intervention. The authors hypothesize that silent microperforations during colonoscopy contributed to the infection. Although 20% to 40% of reported PLA cases are cryptogenic in the literature, it may be because of failure to recognize and report a precipitating factor such as colonoscopy. As more cases similar to the present case are reported, the number of cryptogenic cases may decrease.

Infections associated with solid malignancies

Although solid tumors comprise the vast majority of cancers, the incidence of serious infectious complications in this population is much less than in patients with hematologic malignancies. Most infections involving patients with solid tumors comprise two groups. First, patients acquire infections as a result of the cancer itself, due to either mass effect that interrupts normal function or destruction of the normal barriers to infection. Second, patients acquire infections as a complication of the treatments they receive, such as chemotherapy, radiation, surgery, or medical devices. Advances in the management of cancer have resulted in a gradual stepwise improvement in survival for patients with most types of solid tumors. Much of this improvement has been attributed to advances in cancer screening, diagnosis, and therapeutic modalities. In addition, improvements in the prevention, diagnosis, and treatment of infections have likely contributed to this prolonged survival. This review highlights select articles in the medical literature that shed light on the epidemiology and pathophysiology of infections in patients with solid tumors. In addition, this review focuses upon the diagnosis and treatment of these infections and their recent advances.

Should colonoscopy be performed in patients with cryptogenic liver abscess?

BACKGROUND/AIM

The interruption of a mucosal barrier by colon cancer or a polyp can lead to the development of a liver abscess. This study aimed to evaluate the possible contribution of colon cancer to the development of liver abscess and the necessity of colonoscopy in patients presenting with cryptogenic liver abscess.

METHODS

We reviewed the medical records of 268 patients diagnosed with liver abscess between January 2001 and April 2010. Among cases with no definite cause of liver abscess, differences between patients with and without colon cancer were evaluated in terms of clinical, laboratory, imaging, and microbiological findings.

RESULTS

Pyogenic liver abscess with no apparent etiology was encountered 163 patients; colonoscopy was performed in 121 of these 163 patients. The tumor diagnosis was confirmed by total colonoscopy in 12/163 (7.4%) patients with adenocarcinoma and 8/163 (4.9%) patients with high-grade dysplasia. Nine patients were diagnosed with stage I, two patients with stage II, and one with stage III disease according to the tumor, nodes, and metastases (TNM) staging system for colorectal cancer. The prevalence of incidental colon cancer in patients with pyogenic liver abscess was significantly higher than that of normal individuals who underwent colonoscopy (0.8%, 90/11,272) at our health care center.

CONCLUSIONS

Colon cancer may be one etiology of liver abscess. Colonoscopy should be considered in patients with pyogenic liver abscess with not an apparent primary source of infection.

Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study

BACKGROUND/AIMS

No large-scale population-based study has ever been conducted to examine the relationship between cryptogenic pyogenic liver abscesses (PLA) and the subsequent risk of colorectal cancer. This study aimed to estimate the risk for colorectal cancer following a diagnosis of cryptogenic PLA over a 5-year period.

METHODS

The study group comprised 274 patients who visited an outpatient care centre or were hospitalized with a diagnosis of cryptogenic PLA between 2001 and 2003. The comparison group included 1370 randomly selected subjects. Cox proportional hazard regressions were performed to compare the 5-year colorectal cancer-free survival rates for these two groups.

RESULTS

Of the total sample, 40 patients from the study group (2.43%) had colorectal cancer during the 5-year follow-up period: 15 (5.45% of those with cryptogenic PLA) and 25 from the comparison group (1.82% of the comparison group). After adjusting for patients' age, sex, monthly income, level of urbanization and geographical location, the hazard of colorectal cancer during the 5-year period was 3.36 times greater for patients with cryptogenic PLA than for the comparison group [95% confidence interval (CI)=1.72-6.56, P<0.001]. The adjusted hazard of colorectal cancer during the 5-year follow-up period was 5.54 times higher for cryptogetic PLA patients with diabetes (95% CI=2.11-14.56, P<0.001) than the comparison group and 2.64 times higher among PLA patients without diabetes (95% CI=1.19-5.85, P<0.05).

CONCLUSIONS

We conclude that cryptogenic PLA is an alarm that may signal colorectal cancer, especially among female patients with diabetes.