Pyogenic Liver Abscess Secondary to Sigmoid Diverticulitis: An Unusual Presentation

Abstract

Pyogenic liver abscesses, despite being a rare complication of diverticulitis and inflammatory bowel disease, are potentially serious life-threatening pathologies. Diverticular diseases can lead to disruption of the colonic mucosal barrier and can serve as a route for bacterial infection via the portal venous system. This patient had such a delayed presentation due to his atypical symptoms; he developed large abscess formation, detected by computed tomography, eventually requiring an ultrasound-guided drain followed by a colonoscopy. The present report describes an elderly gentleman who developed a bacterial liver abscess due to seeding of a commensal organism caused by sigmoid diverticulitis.

Hepatic Abscess as Early Presentation of Perforated Diverticulitis

“…The presentation of a hepatic abscess can resemble acute cholangitis, with symptoms such as fever, RUQ pain, jaundice, and weight loss [ 1 , 4 ]. Bacteremia can also be present [ 5 ].…”

“…The causative organism in bacterial hepatic abscesses is often identified as Streptococcus intermedius ( S. intermedius ) [ 2 , 4 , 5 ]. The hepatic abscess in our patient was also found to have been caused by S. intermedius .…”

“…Initial management of a single-cavity hepatic abscess consists of percutaneous drainage and antibiotics [ 1 - 6 ]. If multiple hepatic abscesses are present or if the hepatic abscess is loculated, surgical drainage might be necessary [ 2 , 4 ]. Our patient fared well with percutaneous drain placement, 10 days of IV antibiotics and a 20-day course of oral amoxicillin.…”

“…The infection is most commonly bacterial [ 1 ]. Hepatic abscesses have multiple causes, including biliary disease, intra-abdominal collections (appendicitis, diverticulitis, and inflammatory bowel disease), abdominal surgery, liver transplantation, and liver trauma [ 1 - 4 ]. Hepatic abscesses are often complicated by septic shock [ 2 ].…”

“…When diverticulitis is associated with an abscess, fistula, perforation, or obstruction, it is considered to be complicated [ 3 ]. Diverticulitis is thought to cause hepatic abscesses by portal venous route when rupture is present [ 4 ].…”