The Japanese journal of surgery

, Volume 21, Issue 3, pp 348–351 | Cite as

Liver abscess as the initial manifestation of colonic Crohn's disease: Report of a case

  • Hitoshi Kotanagi
  • Sumiyuki Sone
  • Takemi Fukuoka
  • Tomio Narisawa
  • Kenji Koyama
  • Hitoshi Yagisawa
  • Mitsuroh Chiba
  • Osamu Masamune
Case Reports


Liver abscess is a rare complication of Crohn's disease and in most of the reported cases, the diagnosis of Crohn's disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohn's disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohn's disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohn's disease should be included in the differential diagnosis of diseases causing liver abscess.

Key Words

liver abscess Crohn's disease 


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  1. 1.
    Snavely JR. Clinicopathologic conference: Diarrhea and abdominal tenderness. Bull Tulane Univ Med Fac 1946; 6: 22–25.PubMedGoogle Scholar
  2. 2.
    Taylor FW. Regional enteritis complicated by pylephlebitis with multiple liver abscesses. Am J Med 1949; 7: 838–840.PubMedCrossRefGoogle Scholar
  3. 3.
    Lerman B, Garlock JH, Janowitz HD. Suppurative pylephlebitis with multiple liver abscesses complicating regional ileitis: Review of the literature 1940–1960. Ann Surg 1962; 155: 441–448.PubMedGoogle Scholar
  4. 4.
    Sparberg M, Gottschalk A, Kirsner JB. Liver abscess complicating regional enteritis: Report of two cases. Gastroenterology 1965; 49: 548–551.PubMedGoogle Scholar
  5. 5.
    Altemeier WA, Schowengerdt CG, Whiteley DH. Abscesses of the liver: surgical considerations. Arch Surg 1970; 101: 258–265.PubMedGoogle Scholar
  6. 6.
    Kyle J. Crohn's disease. New York: Appleton-Cen-tury-Crofts, 1972.Google Scholar
  7. 7.
    Schraibman G. Non-parasitic liver abscess. Br J Surg 1974; 61: 709–712.PubMedGoogle Scholar
  8. 8.
    Zarnow H, Grant TH, Spellberg M, Levin B. Unusual complications of regional enteritis. Duodenobiliary fistula and hepatic abscess. JAMA 1976; 235: 1880–1881.PubMedCrossRefGoogle Scholar
  9. 9.
    Watts HD. Multiple hepatic abscesses complicating regional enteritis: The importance of prior surgery or corticosteroid therapy. Dig Dis 1978; 23: 41S-47S.CrossRefGoogle Scholar
  10. 10.
    Nelson A, Frank HD, Taubin HL. Liver abscess. A complication of regional enteritis. Am J Gastroenterol 1979; 72: 282–284.PubMedGoogle Scholar
  11. 11.
    Lobatto S, Van De Beek C. Hepatic abscess complicating regional enteritis. Neth J Med 1980; 23: 159–161.PubMedGoogle Scholar
  12. 12.
    Hatoff DE. Perineal Crohn's disease complicated by pyogenic liver abscess during metronidazole therapy. Gastroenterology 1983; 85: 194–195.PubMedGoogle Scholar
  13. 13.
    Brasitus TA, Cleri DJ, Szabo K. Streptococcus MG intermedius (S. milleri). Hepatic abscesses in two patients with regional enteritis. South Med J 1983; 76: 1297–1298.PubMedGoogle Scholar
  14. 14.
    Crass JR. Liver abscess as a complication of regional enteritis: Interventional consideration. Am J Gastroenterol 1983; 78: 747–749.PubMedGoogle Scholar
  15. 15.
    Weinberg RJ, Klish WJ, Brown MR, Smalley JR, Emmens RW. Hepatic abscess as a complication of Crohn's disease. J Pediatr Gastroenterol Nutr 1983; 2: 171–174.PubMedCrossRefGoogle Scholar
  16. 16.
    Saverymuttu SH, Keshavarzian A, Gibson R, Hodson HJF. Hepatic abscess associated with Crohn's disease detected by 111-indium leukocyte scanning. J Clin Gastroenterol 1985; 7: 273–276.PubMedGoogle Scholar
  17. 17.
    Macpherson DS, Scott DJA. Liver abscess and Crohn's disease. Am J Gastroenterol 1985; 80: 399–402.PubMedGoogle Scholar
  18. 18.
    Valero V, Senior J, Watanakunakorn C. Liver abscess complicating Crohn's disease presenting as thoracic empyema: Case report and review of the literature. Am J Med 1985; 79: 659–662.PubMedCrossRefGoogle Scholar
  19. 19.
    Mir-Madjlessi SH, McHenry MC, Farmer RG. Liver abscess in Crohn's disease. Report of four cases and review of the literature. Gastroenterology 1986; 91: 987–993.PubMedGoogle Scholar
  20. 20.
    Casola G, vanSonnenberg E, Neff CC, Saba RM, Withers C, Emarine CW. Abscesses in Crohn's disease: Percutaneous drainage. Radiology 1987; 163: 19–22.PubMedGoogle Scholar
  21. 21.
    Safrit HD, Mauro MA, Jaques PF. Percutaneous abscess drainage in Crohn's disease. AJR 1987; 148: 859–862.PubMedGoogle Scholar
  22. 22.
    Teague M, Baddour LM, Wruble LD. Liver abscess: A harbinger of Crohn's disease. Am J Gastroenterol 1988; 83: 1412–1414.PubMedGoogle Scholar
  23. 23.
    Lambiase RE, Cronan JJ, Dorfman GS, Paolella LP, Haas RA. Percutaneous drainage of abscesses in patients with Crohn's disease. AJR 1988; 150: 1043–1045.PubMedGoogle Scholar
  24. 24.
    Reynolds TB. Medical treatment of pyogenic liver abscess. Ann Intern Med 1982; 96: 373–374.PubMedGoogle Scholar
  25. 25.
    Herbert DM, Rothman J, Simmons F, Fogel DA, Wilson S, Ruskin J. Pyogenic liver abscesses: successful non-surgical therapy. Lancet 1982; i: 134–136.CrossRefGoogle Scholar

Copyright information

© The Japan Surgical Society 1991

Authors and Affiliations

  • Hitoshi Kotanagi
    • 1
  • Sumiyuki Sone
    • 1
  • Takemi Fukuoka
    • 1
  • Tomio Narisawa
    • 1
  • Kenji Koyama
    • 1
  • Hitoshi Yagisawa
    • 2
  • Mitsuroh Chiba
    • 2
  • Osamu Masamune
    • 2
  1. 1.The First Department of SurgeryAkita University School of MedicineAkitaJapan
  2. 2.The First Department of Internal MedicineAkita University School of MedicineAkitaJapan

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