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Newly Diagnosed Liver Abscess Newly diagnosed liver abscess - Colonoscopy required! Manan A Jhaveri, MD1; Priyanka Makkar, MD1; Olivo Raquel, MD1; Kinesh Changela, MD2; 1 1 2 2 Lam Kimberly, MD ; Judith Berger, MD ; Jay P Babich, MD ; Andrea N Culliford, MD Department of Internal Medicine1; Division of Gastroenterology2; St. Barnabas Health System, Bronx, NY . Introduction Discussion Liver abscesses occur as the result of pyogenic or Various etiologies of liver abscess have been amoebic infection and are more commonly found in proposed1. More recently, especially in the immunodeficient patients. Their occurrence is very eastern countries, studies have reported liver rare and only accounts for 0.02% of all hospital abscesses as a silent manifestation of colon admissions1. Klebsiella pneumonia and cancer2-3 and may represent the initial Pseudomonas aeruginosa are the most common manifestation of the disease. causes of liver abscesses especially in Eastern Asian countries. We report a case of a liver abscess This type of pyogenic liver abscess has now mimicking metastasis in a newly diagnosed diabetic been reported worldwide and is regarded as a 3 patient who was later discovered to have an occult herald sign of colorectal cancers . Other sigmoid colon cancer. common associations include the diagnosis of diabetes mellitus type II4. The sigmoid colon is Case Report the most common site of tumor, and Klebsiella Pneumoniae is the most common pathogen isolated in the eastern Asian countries5. The A 45-year-old male from Senegal presented to our Figure - 1 Figure - 2 institution with a three day complaint of epigastric proposed pathogenesis for the above is the abdominal discomfort refractory to antacids, fevers, destruction of the mucosal barrier and repeated malaise and weight loss. Initial laboratory data was bacterial translocation5. significant for mild leukocytosis (WBC:11,800 / µL) and moderate transaminitis (AST/ALT: 67/105 IU/L). Conclusion CT scan of the abdomen and pelvis with contrast demonstrated a 7.5 cm x 7.0 cm mass in the left In patients with cryptogenic liver abscess, hepatic lobe with areas of central necrosis. The colonoscopy should be performed to rule out sigmoid wall thickening with focal irregularity raised an occult colonic lesion. suspicion for a mass lesion (Figure 1). Tumor markers were negative. A colonoscopy References showed a 5 cm pedunculated polyp in the sigmoid colon, which was removed with hot snare 1. Lopez-Cano Gomez M, Laguna Del Estal P, Garcia polypectomy (Figure 2). The polyp was a moderately Montero P, Gil Navarro M, Castaneda Pastor A. [Pyogenic liver abscess: clinical presentation and predictors of differentiated invasive adenocarcinoma without unfavorable outcome]. Gastroenterologia y hepatologia. lymph or vascular invasion and clear margins Apr 2012;35(4):229-235 (Figure 3). 2. Giuliani A, Caporale A, Demoro M, Scimo M, Galati F, Galati G. Silent colon carcinoma presenting as a hepatic A liver biopsy was performed due to persistent abscess. Tumori. Nov-Dec 2007;93(6):616-618. Figure - 3 Figure - 4 3. Ballardini P, Gamberini S, Margutti G, Manfredini R. temperature spikes and was consistent with a Hepatic abscess and silent underlying colon cancer: an hepatic abscess. Cultures were positive for emerging association? Tumori. Jul-Aug 2008;94(4):624. Klebisella Pneumoniae (Figure 4). 4. Hsu WH, Yu FJ, Chuang CH, Chen CF, Lee CT, Lu CY. Occult colon cancer in a patient with diabetes and The plan was to treat the abscess with antibiotic recurrent Klebsiella pneumoniae liver abscess. The followed by surgical resection. A CT scan of the Kaohsiung journal of medical sciences. Feb 2009;25(2):98-103 st abdomen/pelvis was obtained on the 21 day after 5. Huang WK, Chang JW, See LC, et al. Higher rate of initiation of antibiotics and it demonstrated almost colorectal cancer among patients with pyogenic liver complete resolution of liver lesion (Figure 5). abscess with Klebsiella pneumoniae than those without: an 11-year follow-up study. Colorectal disease : the official Patient successfully underwent laparoscopic lower journal of the Association of Coloproctology of Great Britain and Ireland. Dec 2012;14(12):e794-801 anterior resection of the sigmoid colon. Pathology demonstrates residual tubular adenoma with 05 / 2015 IRB # 2015.36 unremarkable margins and lymph nodes. Figure - 5 .
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