Cryptogenic pyogenic liver abscess as the herald of colon cancer.
J Gastroenterol Hepatol. 2011 Jul 20;
Authors: Jeong SW, Jang JY, Lee TH, Kim HG, Hong SW, Park SH, Kim SG, Cheon YK, Kim YS, Cho YD, Kim JO, Kim BS, Lee EJ, Kim TH
Background and Aim: Colonic mucosal defects might be a route for bacterial invasion into the portal system with subsequent hematogenous spread to the liver. We retrospectively investigated the results of colonoscopy and clinical characteristics of patients with pyogenic liver abscess of colonic origin. Methods: A total of 230 consecutive patients with pyogenic liver abscess were reviewed between 2003 and 2010. The 230 patients were categorized into three groups [pancreato-biliary (n = 135), cryptogenic (n = 81), and others (n = 14)]. Of the 81 cryptogenic patients, 37 (45.7%) underwent colonoscopy. Colonic lesions with mucosal defects were considered colonic causes of abscess. Results: In the 37 colonoscopic investigations, colon cancer was found in six patients (16.2%), laterally spreading tumor (LST) in two patients (5.4%), multiple colon ulcers in one patient (2.7%), colon polyps in 17 patients (45.9%), and diverticula in four patients (10.8%). Nine (11%) of 81 cryptogenic abscesses were therefore reclassified as being of colonic origin (colon cancer = 6, LST = 2, ulcer = 1). Three cases were stage III colon cancer, and the others were stage I. Two LSTs were high grade dysplasia. The percentage of patients with Klebsiella pneumoniae (K. pneumoniae) and diabetes mellitus (DM) of colonic origin was 66.7%, which was significantly higher than 8.6% of other causes (p < 0.001). Conclusions: Of 37 patients with cryptogenic pyogenic liver abscess who underwent colonoscopy, nine (24.3%) were diagnosed with a colonic cause. Colonoscopy should be considered for detection of hidden colonic malignant lesions in patients with cryptogenic pyogenic liver abscess, especially for patients with K. pneumoniae and DM.
PMID: 21777280 [PubMed - as supplied by publisher]