Colorectal Cancer Liver Metastasis Presenting as Pneumoperitoneum: Case Report and Literature Review

Abstract

Pneumoperitoneum presenting as air under diaphragm on erect chest X-ray is usually a result of hollow viscous perforation but can be a result of many other diagnoses including necrotising enterocolitis and ruptured liver abscess. We report a case of colon cancer with liver metastases presenting as pneumoperitoneum. This was a result of infection of the metastases with Clostridium septicum with resultant rupture in to sub diaphragmatic space.

Pneumoperitoneum and Gas-Forming Liver Abscesses as Initial Signs of Colorectal Liver Metastases

“…Liver abscesses typically complicate large metastases that have become ischaemic leading to an ideal anaerobic environment for the growth of Clostridium septicum. This may result in rupture into the sub-diaphragmatic space causing gas-forming liver abscesses and pneumoperitoneum [4][5][6].…”

Impact of beta-glucan on the intestinal microbiota of a high risk colon cancer population (polypectomised patients)

“…perfringens, and Cl. difficile, are related to CRC carcinogenesis [Raghavendra et al 2013, Stecher and Hardt 2008, Wentling et al 2006, Sungkanuparph et al 2002, Nakamura et al 2002, Rechner et al 2001, Bodey et al 1991. They possibly act as opportunistic pathogens (passenger bacteria) and may be involved in tumour progression through the induction of a proinflammatory response [Stecher and Hardt 2008, Wentling et al 2006, Candela et al 2014].…”