Abstract
PURPOSE: Carcinoma of the colon, manifested clinically as an enterococcal hepatic abscess, in the absence of liver metastases, is very uncommon. However, having treated a patient with such a condition, we would like to draw the attention of surgeons to this possibility. Most reports describe secondary infections of hepatic metastases only in patients with a known malignancy. However, increased awareness of colonic cancer as an underlying cause of pyogenic liver abscesses will afford earlier diagnosis and treatment. METHODS: The case was analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: A 66-year-old woman presented with abdominal pain, fever, and chills. Imaging scans revealed a solitary liver abscess, which was successfully treated with percutaneous drainage and broad-spectrum intravenous antibiotics. Pus cultures grewStreptococcus faecalis.A search for the underlying cause led to the discovery of an adenocarcinoma of the sigmoid colon. CONCLUSIONS: An aggressive search for the underlying cause of pyogenic liver abscesses should be an integral part of the definitive treatment of this disease. After prevailing etiologies have been excluded, silent colonic cancer should be considered.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Moore-Gillon JC, Eykeyn SJ, Phillips I. Microbiology of pyogenic liver abscess. BMJ 1981;283:819–21.
Klatchko BA, Schwartz SI. Diagnostic and therapeutic approaches to pyogenic abscess of the liver. Surg Gynecol Obstet 1989;168:332–6.
Satiani B, Davidson ED. Hepatic abscesses: improvement in mortality with early diagnosis and treatment. Am J Surg 1978;135:647–50.
Bertel CK, van Heerden JA, Sheedy PF. Treatment of pyogenic hepatic abscesses. Surgical vs. percutaneous drainage. Arch Surg 1986;121:554–8.
Miedema BW, Dineen P. The diagnosis and treatment of pyogenic liver abscesses. Arch Surg 1984;200:328–35.
Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess: changes in etiology, diagnosis and management. Ann Surg 1990;212:655–62.
Cohen JL, Martin FM, Rossi RL, Schoetz DJ Jr. Liver abscess: the need for complete gastrointestinal evaluation. Arch Surg 1989;124:561–4.
Donovan AJ, Yellin AE, Ralls PW. Hepatic abscess. World J Surg 1991;15:162–9.
Marcus SG, Walsh TJ, Pizzo PA, Danforth DN Jr. Hepatic abscess in cancer patients: characterization and management. Arch Surg 1993;128:1358–64.
Ochsner A, Debakey M, Murray S. Pyogenic abscess of the liver, II: an analysis of forty-seven cases with review of the literature. AmJ Surg 1938;40:292–319.
Gyorffy EJ, Frey CF, Silva J Jr, McGahan J. Pyogenic liver abscess: diagnostic and therapeutic strategies. Ann Surg 1987;206:699–705.
Lonardo A, Grisendi A, Pulvirenti M,et al. Right colon adenocarcinoma presenting as Bacteroides fragilis liver abscess. J Clin Gastroenterol 1992;14:335–8.
Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess: modern treatment. Arch Surg 1991;126:991–6.
Braunwald E, Isselbacher KJ, Petersdorf RJ, Wilson JD, Martin JB, Fauci AS. Harrison's principles of internal medicine. 11th ed. New York: McGraw-Hill, 1987:549.
Klein RS, Recco RA, Catalano MT, Edberg SC, Casey JI, Steigbigel NH. Association of streptococcus bovis with carcinoma of the colon. N Engl J Med 1977;297:800–2.
Gerzof SG, Johnson WC, Robbins AH, Nabseth DC. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage. Am J Surg 1985;149:487–94.
Lee JF, Block GE. The changing clinical pattern of hepatic abscesses. Arch Surg 1972;104:465–70.
Johnson RD, Mueller PR, Ferrucci JT,et al. Percutaneous drainage of pyogenic liver abscesses. AJR Am J Roentgenol 1985;144:463–7.
Author information
Authors and Affiliations
About this article
Cite this article
Teitz, S., Guidetti-Sharon, A., Manor, H. et al. Pyogenic liver abscess: Warning indicator of silent colonic cancer. Dis Colon Rectum 38, 1220–1223 (1995). https://doi.org/10.1007/BF02048342
Issue Date:
DOI: https://doi.org/10.1007/BF02048342