Pyogenic liver abscess: Warning indicator of silent colonic cancer

Teitz, Sigal; Guidetti-Sharon, Ahuva; Manor, H; Halevy, Ariel

doi:10.1007/bf02048342

Cited by 72 publications

(35 citation statements)

References 15 publications

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“…The potential mechanisms of abscess formation include bacteremia as a result of a hematogenous spread from the tumor, direct extension of the intraperitoneal infection along the portal vein or a secondary infection of metastases. Since the patient in the present report was elderly and diabetic, impairment of the immune system may have been associated with the formation of multiple abscesses in addition to the colon cancer (13,22,23).…”

Section: A B Cmentioning

confidence: 73%

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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Section: A B Cmentioning

confidence: 73%

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

et al. 2015

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“…It is believed that ulceration of the neoplastic lesion forms a pathway for the microorganism to enter the bloodstream (22) , although this does not explain the cases of patients with infectious endocarditis and nonulcerated colonic polyps (6) . Infectious endocarditis from S. bovis habitually affects patients aged over 60 years (25) , as occurred in this case. Its most important complication is cardiac insufficiency, occurring mainly in the aortic valve (12,19) , which was also present in the patient described.…”

Section: Discussionmentioning

confidence: 84%

Infectious endocarditis from Streptococcus bovis associated with colonic carcinoma: case report and literature review

Waisberg

Matheus

Pimenta

2002

Arq. Gastroenterol.

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-Background -Many studies in the literature have warned of the need for investigation of colonic lesions among patients, especially elderly ones, who have bacteremia and/or endocarditis from Streptococcus bovis. Bacteremia and infectious endocarditis from Streptococcus bovis may be related to the presence of neoplastic lesions in the large intestine and hepatic disease. Aim -This report describes a patient who presented infectious endocarditis from Streptococcus bovis associated with colonic carcinoma and tubular-villous adenomas. Conclusions -The finding of this bacterium among patients with septicemia and/or endocarditis is also related to the presence of villous or tubular-villous adenomas in the large intestine. For this reason, complete and detailed investigation of the large intestine must be performed in patients with infectious endocarditis, even in the absence of intestinal symptoms. An increased incidence of this condition or hepatic dysfunction has been reported among patients with infectious endocarditis from Streptococcus bovis. Patients with infectious endocarditis from Streptococcus bovis and normal colonoscopy may be included in the group at risk for developing colonic cancer. The knowledge that there is an association between endocarditis from Streptococcus bovis and carcinoma of the colon has important clinical implications. If the lesion can be discovered at an early stage, curative resection may become possible.

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“…Recent reports suggest that pyogenic liver abscess might be a warning indicator of silent colonic cancer [4,5,[12][13][14] , therefore, patients with liver abscess but without apparent etiologies, as in Case 1 of this report, should have further examination. In addition, non-growth in cultures of blood samples and abscess aspirate in Case 1 could be due to www.wjgnet.com the following two possibilities: (1) the patient had been partially treated at an outside hospital; (2) the pathogen of the liver abscess might be an anaerobe that was most probably originated from the colon.…”

Section: Discussionmentioning

confidence: 99%

Pyogenic liver abscess associated with large colonic tubulovillous adenoma

Lai¹,

Chan

Peng³

et al. 2006

WJG

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tract disease or intra-abdominal infections including cholecystitis, suppurative cholangitis, suppurative pylephlebitis, appendicitis, diverticulitis and peritonitis [1][2][3] . Recently, colorectal cancer without obvious infection was considered as one of the uncommon etiologies of liver abscess [4,5] . Furthermore, liver abscess was reported as the presenting manifestation of colonic tubulovillous adenoma [6] . However, there are a growing number of reports suggesting a relationship between diabetes mellitus (DM) and Klebsiella pneumonia (KP) liver abscess which indicate that a deficiency in the hosts' defense mechanism could be the etiology of this liver infection [7][8][9] . We hereby report two cases of pyogenic liver abscess both of which were found to have colonic tubulovillous adenoma two to three weeks later after the diagnosis of liver abscess. The association of pyogenic liver abscess and colonic tubulovillous adenoma and the implications of these two cases are discussed. CASE REPORT CASE 1A 67-year-old man, who was referred from a local hospital, was admitted to our hospital because of fever, chill, and right upper abdominal pain for seven days. On physical examination, his initial body temperature was 37.9 o C and blood pressure was 124/67 mmHg. Light palpation of the abdomen revealed tenderness and mild rebounding pain on epigastric and right upper areas, but no abdominal mass was felt. Significant laboratory data included a leukocyte count of 26,330/mL (normal range = 4000-10,400/mL ), a hemoglobin of 9.5 gm/dL (normal range = 12-16 gm/dL), an aspartate aminotransferase (AST) of 73 IU/L (normal range = 5-34 IU/L), an alanine aminotranferase (ALT) of 79 IU/L (normal range = 0-40 IU/L), a fasting blood sugar of 118 mg/dl (normal range = 70-110 mg/dL), a total bilirubin of 1.03 mg/dL (normal range = 0.2-1.3 mg/dL), a C-Reactive Protein (CRP) of 17.02 mg/dL (normal <0.8 mg/dL), and a carcinoembryonic antigen (CEA) level of 0.33 ng/dL (normal <5 ng/dL).Abdominal ultrasonography (US) and computed tomography (CT) showed a 4-cm liver abscess in left lobe of liver ( Figure 1A). After three sets of blood cultures were completed and broad-spectrum antimicrobial therapy was initiated, CT-guided percutaneous drainage of the liver abscess was performed and pus liked material was aspirated and sent for bacterial culture. However, blood and pus were all negative for bacterial growth. As antimicrobial treatment was continued, the patient's clinical condition improved rapidly and fever subsided four days CASE REPORT P yo g en ic liver absc ess a s s o c i a t e d w i t h l a r g e c o l o n i c tubulovillous adenomaHsueh-Chou Lai, Cho-Yu Chan, Cheng-Yuan Peng, Chih-Bin Chen, Wen-Hsin Huang AbstractPyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history ...

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Pyogenic liver abscess: Warning indicator of silent colonic cancer

Abstract: 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.

Cited by 72 publications

References 15 publications

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

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

Infectious endocarditis from Streptococcus bovis associated with colonic carcinoma: case report and literature review

Pyogenic liver abscess associated with large colonic tubulovillous adenoma

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