Higher rate of colorectal cancer among patients with pyogenic liver abscess with<i>Klebsiella pneumoniae</i>than those without: an 11‐year follow‐up study

Huang, Wen‐Shih; Chang, Jeng-Shou; See, Lai‐Chu; Tu, Hui‐Tzu; Chen, J.-S.; Liaw, Chuang-Chi; Lin, Yu‐Sheng; Yang, Tse-Yen

doi:10.1111/j.1463-1318.2012.03174.x

Cited by 52 publications

(44 citation statements)

References 29 publications

(38 reference statements)

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“…This was obviously higher than those of the previous reports regarding pathogens in the similar geographical area [28,32,33,34]. A retrospective, 11-year follow-up study for PLA asserted that patients with K. pneumoniae PLA had a significantly higher rate of subsequent CRC than did patients with non- K. pneumoniae PLA [35]. Another study also reported that the percentage of K. pneumoniae in abscesses of colonic origin was higher than that of other origins [15].…”

Section: Discussioncontrasting

confidence: 54%

Computed Tomographic Colonography Is Valuable for Post-Treatment Evaluation and Screening of Hidden Colorectal Cancer in Patients with Cryptogenic Pyogenic Liver Abscess

Jang

Jeong²,

Lee³

et al. 2014

Digestion

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Background/Aims: It has been demonstrated that cryptogenic pyogenic liver abscess (PLA) is associated with colonic mucosal defect, especially colorectal cancer (CRC). Therefore, the screening of CRC in patients with cryptogenic PLA is important. This study was to investigate whether computed tomographic colonography (CTC) has value as a follow-up modality as well as CRC screening tool in patients with PLA. Methods: A retrospective evaluation of 109 patients with cryptogenic PLA who underwent CTC or colonoscopy for CRC screening between July 2005 and July 2012 was performed. The patients were divided into a CTC group (n = 68) and colonoscopy group (n = 41) after treatment of liver abscess, and compared concerning the detection rate of advanced neoplasia, consisting of advanced adenomas and invasive carcinomas. Patients with advanced polyps in CTC surveillance underwent subsequent colonoscopy. Results: Advanced colonic neoplasia was detected in 9 of the 68 patients (13.2%) in the CTC group and 8 of the 41 patients (19.5%) in the conventional colonoscopy group (p = 0.42). The treatment response of all abscess lesions was clearly visualized on CTC, with complete resolution in 17.6% (12/68) of patients. After adjustment for sex and pathogens, old age (≥65 years) was significantly associated with advanced neoplasia (OR 5.481; 95% CI 1.757-17.100; p = 0.03). Conclusion: CTC has a valuable dual role as a follow-up modality and in the screening of CRC in patients with cryptogenic PLA, particularly in elderly patients over 65 years of age.

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Section: Discussioncontrasting

confidence: 54%

Computed Tomographic Colonography Is Valuable for Post-Treatment Evaluation and Screening of Hidden Colorectal Cancer in Patients with Cryptogenic Pyogenic Liver Abscess

Jang

Jeong²,

Lee³

et al. 2014

Digestion

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“…It is uncommon for colorectal cancer to present with liver abscess and this is reported to occur in ≤5% of patients (20,21).The incidence of abscess formation due to colorectal cancer is highest in the liver, followed by the lungs, and cases of endocarditis and meningitis have also been reported (8)(9)(10)(11)(12)(13)(14)(15)(16). However, to the best of our knowledge there has only been 1 reported case of early colorectal cancer associated with a liver abscess (1), in addition to 2 cases of multiple abscesses due to colorectal cancer (12,16); therefore, the patient in the present case report is the first to be reported with multiple abscesses caused by early rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge there has only been 1 reported case of early colorectal cancer associated with a liver abscess (1), in addition to 2 cases of multiple abscesses due to colorectal cancer (12,16); therefore, the patient in the present case report is the first to be reported with multiple abscesses caused by early rectal cancer. The majority of the bacteria isolated from abscesses associated with colorectal cancer are gram negative rods such as Klebsiella (50.0%) or Fusobacterium (6.90%) species (14,15). Klebsiella with the same antibiotic sensitivity profile was isolated …”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that multiple abscess formation can be one manifestation of colorectal cancer. Cohen et al (24) and Huang et al (15) reported that it is necessary to investigate the gastrointestinal tract in patients who develop an abscess of unknown etiology. For management of colorectal cancer associated with an abscess, it is common to initially treat the abscess conservatively with antibiotics and drainage and then perform definitive surgery for the cancer once the abscess has resolved.…”

Section: A B Cmentioning

confidence: 99%

“…The incidence of postoperative local recurrence in the pelvic cavity is low (5)(6)(7). However, it is not uncommon for colon cancer to cause an abscess in a distant organ (8)(9)(10)(11)(12)(13)(14)(15)(16). Regarding the pathogenesis of systemic abscesses associated with colorectal cancer, small abscesses may form around the tumor or bacterial invasion may occur secondary to damage to the intestinal wall, which is followed by hematogenous spread (13).…”

Section: Introductionmentioning

confidence: 99%

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Early rectal cancer accompanied by multiple systemic abscesses: A case report

et al. 2015

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Abstract.A 70-year-old man undergoing treatment for diabetes presented with a cough and pyrexia that has lasted one week. Laboratory tests demonstrated evidence of inflammation. The patient was hospitalized and antibiotic treatment was initiated, but the condition of the patient did not improve. After 2 weeks, computerized tomography scanning demonstrated the presence of multiple small nodules in the lungs and a liver abscess. The patient also developed neck pain and numbness of the upper extremities and was then transferred to Tokai University Hachioji Hospital (Tokyo, Japan). Percutaneous transhepatic drainage (PTD) of the liver abscess was performed and antibiotic treatment was initiated. Detailed examination revealed there was pyogenic spondylitis of the cervical spine, therefore abscess drainage and an anterior cervical spinal fusion were performed. Culture of each lesion resulted in Klebsiella pneumoniae growth. While continuing antibiotic treatment and rehabilitation, the gastrointestinal tract was investigated and evidence of early rectal cancer was observed. The pulmonary nodules disappeared during treatment, indicating that these were multiple lung abscesses. Four weeks following abscess drainage and anterior cervical spinal fusion, lower anterior resection was performed. The present case report describes a patient who developed multiple abscesses associated with early rectal cancer and discusses the case with reference to the literature. IntroductionAt present, the global incidence of colorectal cancer is increasing, which is considered to be a result of westernization of the diet and obesity (1-4). The main symptoms are rectal bleeding with or without progressive anemia and weight loss. The recommended treatment for stage I colorectal cancer is surgical resection combined with lymph node dissection (5).The 5-year survival rate of patients following resection of stage I colorectal cancer is 90-95%, with postoperative distant metastasis/recurrence occuring in 5-10% of patients (5). The incidence of postoperative local recurrence in the pelvic cavity is low (5-7). However, it is not uncommon for colon cancer to cause an abscess in a distant organ (8-16). Regarding the pathogenesis of systemic abscesses associated with colorectal cancer, small abscesses may form around the tumor or bacterial invasion may occur secondary to damage to the intestinal wall, which is followed by hematogenous spread (13). The development of abscesses may be promoted by the impaired immunity of tumor-bearing patients and associated diseases, such as diabetes, may also affect immunity (12,13). In the literature, five cases of colorectal cancer in which liver abscesses were the chief complaint have been reported. Of these five cases, 1 early cancer patient (8) and 3 advanced cancer patients exhibited liver abscesses alone (9,10,13) and 1 advanced cancer patient exhibited multiple systemic abscesses (12). Fever was the main symptom in all cases, with weight loss, malaise and nausea/vomiting also observed (8)(9)(10)12,13). In addit...

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Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess

Suzuki,

Kidder,

Tanaka

et al. 2023

JAMA Netw Open

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ImportanceColorectal cancer (CRC) can compromise the mucosal barrier and subsequently allow a route for bacterial invasion into the portal system or systemic circulation. Despite preliminary data suggesting that patients who experienced pyogenic liver abscess (PLA) have higher CRC incidence rates, data from outside the Southeast Asian population are sparse.ObjectiveTo investigate whether there is an association between PLA and the subsequent incidence of diagnosed CRC using the Veterans Health Administration (VHA) cohort.Design, Setting, and ParticipantsA patient-level matched retrospective cohort study was conducted at 127 VHA hospitals across the US from January 1, 2003, to December 31, 2020. Patients were followed up to 10 years from PLA diagnosis. Data analysis was performed from April 14, 2002, to October 31, 2023. All patients who were admitted to VHA hospitals with a diagnosis of PLA were included. For each patient with PLA, up to 3 controls without diagnosis of PLA, matching age, sex, and health care facility, were selected.ExposurePyogenic liver abscess.Main Outcomes and MeasuresThe primary outcome was CRC diagnosis during the follow-up period. A multivariable Fine-Gray subdistribution regression model with time-dependent coefficient was used to estimate the time-varying hazard ratio (HR) of CRC incidence while accounting for mortality as a competing event.ResultsA total of 8286 patients with PLA (male, 96.5%; mean [SD] age, 65.8 [11.9] years) and 23 201 patient-level matched controls (male, 96.3%; mean age, 65.3 [11.7] years) were included. A diagnosis of CRC was found in a significantly higher proportion of patients with PLA compared with controls (1.9% [159 of 8286] vs 0.8% [196 of 23 201]; P &lt; .001). The incidence of CRC was significantly higher among patients with PLA during the first 3 years from PLA diagnosis (HR, 3.64; 95% CI, 2.70-4.91 at 0.5 years; HR, 2.51; 95% CI, 1.93-3.26 at 1 year; HR, 1.74; 95% CI, 1.33-2.28 at 2 years; and HR, 1.41; 95% CI, 1.05-1.89 at 3 years), but not significant after 3 years. This association was not observed among patients whose PLA was likely secondary to cholangitis or cholecystitis (HR, 1.78; 95% CI, 0.89-3.56 at 0.5 years).Conclusions and RelevanceIn this patient-level matched retrospective cohort study, a significantly higher incidence of CRC was observed up to 3 years from PLA diagnosis. The findings suggest that offering CRC screening for patients with cryptogenic PLA may be useful, especially patients who have not been screened according to guidelines.

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Higher rate of colorectal cancer among patients with pyogenic liver abscess withKlebsiella pneumoniaethan those without: an 11‐year follow‐up study

Abstract: Patients with K. pneumoniae PLA had a significantly higher rate of subsequent CRC than did patients with non-K. pneumoniae PLA. Colonoscopy is recommended to detect occult colonic malignancy in patients with PLA, particularly for patients over 60 years of age and with K. pneumoniae.

Cited by 52 publications

References 29 publications

Computed Tomographic Colonography Is Valuable for Post-Treatment Evaluation and Screening of Hidden Colorectal Cancer in Patients with Cryptogenic Pyogenic Liver Abscess

Computed Tomographic Colonography Is Valuable for Post-Treatment Evaluation and Screening of Hidden Colorectal Cancer in Patients with Cryptogenic Pyogenic Liver Abscess

Early rectal cancer accompanied by multiple systemic abscesses: A case report

Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess

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