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Ibrahim S, Nallapaneni NN, Muthulingam D. Liver Abscess Caused by Klebsiella Pneumoniae in the Absence of Hepatobiliary Disease. Cureus 2022; 14:e29789. [PMID: 36340565 PMCID: PMC9618281 DOI: 10.7759/cureus.29789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Klebsiella pneumoniae is notorious for causing abscesses in patients without any previous hepatobiliary disease and is a cause of liver abscesses. We report the case of a 70-year-old man with a past medical history of hypertension and benign prostatic hyperplasia who presented with a cough and fever lasting two weeks. The findings from his physical examination were unremarkable, but his laboratory investigations were significant for elevated inflammatory markers. A computed tomography scan of his abdomen revealed a complex septated cyst in the right lobe of his liver, and his blood culture was positive for K. pneumoniae. He responded well to drainage and intravenous and oral antibiotics. His abscess resolved fully. Cases of K. pneumoniae in the United States are rare, and studies are necessary to explore its epidemiology. Atypical symptoms make diagnosis a challenge, and physicians are urged to retain high levels of suspicion to diagnose and treat such cases early.
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2
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Kim TH, Heo NY, Park SH, Moon YS, Kim TO, Park J, Choi JH, Park YE, Lee J. Pyogenic Liver Abscess or Liver Cyst Infection after Colonoscopic Polypectomy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 75:300-304. [PMID: 32448861 DOI: 10.4166/kjg.2020.75.5.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/03/2022]
Abstract
A pyogenic liver abscess (PLA) mostly occurs in association with biliary tract disease, but some PLAs have no apparent underlying cause, i.e., they are cryptogenic. The authors experienced three cases of PLA or liver cyst infection after colon polypectomy without other distinct etiologies. These cases suggest that colonoscopic polypectomy can cause a mucosal defect that provides a route for bacteria to invade the portal system or spread intraperitoneally to the liver. Colonoscopic polypectomy should be considered as a procedure that might cause PLA. Moreover, clinicians should be aware of this possibility if a patient complains of fever or abdominal pain after a colonoscopic polypectomy.
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Affiliation(s)
- Tae Hyung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nae-Yun Heo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Ha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Soo Moon
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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3
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Lee JS, Kwon YH. Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer. Clin Endosc 2019; 52:620-623. [PMID: 31357750 PMCID: PMC6900301 DOI: 10.5946/ce.2018.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/08/2019] [Indexed: 11/23/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4-cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.
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Affiliation(s)
- Joon Seop Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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4
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Jolobe OMP. Klebsiella-related liver abscess as a manifestation of occult colorectal and biliary tract cancer. QJM 2019; 112:555. [PMID: 30325461 DOI: 10.1093/qjmed/hcy236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- O M P Jolobe
- Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK
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5
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Giuliani A, Caporale A, Demoro M, Scimò M, Galati F, Galati G. Silent Colon Carcinoma Presenting as a Hepatic Abscess. TUMORI JOURNAL 2018; 93:616-8. [DOI: 10.1177/030089160709300618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases. A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.
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Affiliation(s)
- Andrea Giuliani
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Alessandro Caporale
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Martino Demoro
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Michele Scimò
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Francesca Galati
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - Gaspare Galati
- Department of Surgery “Pietro Valdoni”, Policlinico Umberto I, La Sapienza University, Rome, Italy
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6
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Chu CS, Lin CC, Peng CY, Chuang PH, Su WP, Lai SW, Chen HJ, Chung CJ, Lai HC. Does pyogenic liver abscess increase the risk of delayed-onset primary liver cancer?: Evidence from a nationwide cohort study. Medicine (Baltimore) 2017; 96:e7785. [PMID: 28834881 PMCID: PMC5572003 DOI: 10.1097/md.0000000000007785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Delayed-onset primary liver cancer (PLC) including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in patients with pyogenic liver abscess (PLA) is not common. The relationship between PLA and delayed-onset PLC is unclear. We investigated the association in a nationwide cohort study.From Taiwan National Health Insurance claims data, a cohort of 17,531 patients with PLA was generated after excluding patients with a history of cancer (n = 2034) and those diagnosed with PLC (n = 572) and other cancers (n = 627) within 1 year of a diagnosis of PLA. An age-, sex-, index year-, and diabetes mellitus (DM)-matched control cohort of 70,124 persons without PLA was selected from the same dataset. Both cohorts were followed up until the end of 2011. The risk of PLC was estimated for both cohorts.The incidence of PLC was nearly 2-fold greater in the PLA group than in the control cohort (29.3 per 10,000 person-years vs. 16.2 per 10,000 person-years). The incidences of HCC and ICC were 1.5- (22.1 per 10,000 person-years vs. 15.0 per 10,000 person-years) and 11-fold greater (6.73 per 10,000 person-years vs. 0.62 per 10,000 person-years), respectively, in the PLA group than in the control cohort. The PLA cohort also had high risks of PLC (adjusted hazard ratio [aHR] = 1.56; 95% confidence interval [CI] = 1.35-1.81), HCC (aHR = 1.34; 95% CI = 1.15-1.57), and ICC (aHR = 6.94; 95% CI = 4.23-11.57).In conclusion, in this nationwide cohort study, PLA increased the risk of delayed-onset PLC.
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Affiliation(s)
- Chia-Sheng Chu
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Po-Heng Chuang
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Wen-Pang Su
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Shih-Wei Lai
- School of Medicine, China Medical University
- Department of Family Medicine
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
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7
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Bac S, Bac DJ. The Development of a Liver Abscess after Screening Colonoscopy: A Calculated Risk? Eur J Case Rep Intern Med 2017; 4:000650. [PMID: 30755959 PMCID: PMC6346913 DOI: 10.12890/2017_000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
We present the case of a patient who developed a liver abscess following screening colonoscopy. A colorectal screening program was introduced in the Netherlands in 2014 in order to reduce mortality from colorectal cancer. The patient in this report, a 63-year-old man with no significant medical history, underwent polypectomy of two polyps. Four days afterwards he presented to our emergency department with fever, nausea and vomiting. He was diagnosed with a Klebsiella pneumoniae liver abscess and was successfully treated with antibiotics for 6 weeks. This case highlights one of the risks of screening colonoscopy. Given the high number of colonoscopies due to the colorectal screening programs, we should be aware of complications in this mostly asymptomatic group of patients.
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Affiliation(s)
- Simon Bac
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Jan Bac
- Department of Gastroenterology, Gelderse Vallei Hospital, Ede, The Netherlands
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Rahmani G, Moran AM. Pyogenic Liver Abscess Following an Uncomplicated Colonoscopy. Eur J Case Rep Intern Med 2017; 4:000565. [PMID: 30755933 PMCID: PMC6346875 DOI: 10.12890/2017_000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 01/12/2017] [Indexed: 12/02/2022] Open
Abstract
Pyogenic liver abscess is a potentially devastating clinical entity associated with significant morbidity and mortality[1]. A myriad of causes for liver abscess have been described including intra-abdominal infections such as diverticulitis[2]. Due to a non-specific presentation, clinicians often require a high level of suspicion in their diagnosis of this condition. A handful of cases of liver abscess have been described following colonoscopy which was usually a complicated procedure or one where multiple biopsies had been taken[3,4]. The case of a patient presenting pyrexia of unknown origin one week after undergoing an uncomplicated colonoscopy in which no biopsies were taken is reported. She was ultimately diagnosed with a pyogenic liver abscess.
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Affiliation(s)
- George Rahmani
- Department of Nephrology and General Medicine, Letterkenny General Hospital, Letterkenny, Ireland
| | - Anne-Marie Moran
- Department of Nephrology and General Medicine, Letterkenny General Hospital, Letterkenny, Ireland
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Liu L, Chen W, Lu X, Zhang K, Zhu C. Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China. J Emerg Med 2016; 52:409-416. [PMID: 27765437 DOI: 10.1016/j.jemermed.2016.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed. RESULTS The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%). CONCLUSIONS Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome.
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Affiliation(s)
- Li Liu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wanjun Chen
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaoye Lu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Keji Zhang
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Changqing Zhu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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10
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Mavilia MG, Molina M, Wu GY. The Evolving Nature of Hepatic Abscess: A Review. J Clin Transl Hepatol 2016; 4:158-68. [PMID: 27350946 PMCID: PMC4913073 DOI: 10.14218/jcth.2016.00004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 12/19/2022] Open
Abstract
Hepatic abscess (HA) remains a serious and often difficult to diagnose problem. HAs can be divided into three main categories based on the underlying conditions: infectious, malignant, and iatrogenic. Infectious abscesses include those secondary to direct extension from local infection, systemic bacteremia, and intra-abdominal infections that seed the portal system. However, over the years, the etiologies and risks factors for HA have continued to evolve. Prompt recognition is important for instituting effective management and obtaining good outcomes.
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Affiliation(s)
- Marianna G. Mavilia
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA
- *Correspondence to: Marianna G. Mavilia, University of New England College of Osteopathic Medicine, 11 Hills Beach Road, Biddeford, ME 04005, USA. Tel: +1-617-435-1185, Fax: +1-860-679-6582,
| | - Marco Molina
- Department of Radiology, UCONN Health, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
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Jang DK, Jeong SH, Lee SH, Lee M, Jang ES, Kim JW, Hwang JH, Ryu JK, Kim YT, Lee YJ, Lee KH, Kim YH. Computed tomographic colonography is valuable for post-treatment evaluation and screening of hidden colorectal cancer in patients with cryptogenic pyogenic liver abscess. Digestion 2015; 89:175-83. [PMID: 24714400 DOI: 10.1159/000356534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/18/2013] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lai HC, Lin CC, Cheng KS, Kao JT, Chou JW, Peng CY, Lai SW, Chen PC, Sung FC. Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study. Gastroenterology 2014; 146:129-37.e1. [PMID: 24095786 DOI: 10.1053/j.gastro.2013.09.058] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 09/23/2013] [Accepted: 09/29/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The relationship between pyogenic liver abscess (PLA) and gastrointestinal (GI) cancer was first reported more than 20 years ago, yet little is known about this connection. We evaluated this association in a population-based, retrospective, cohort study. METHODS Using Taiwan National Health Insurance claims data, we collected data on a cohort of 14,690 patients with PLA diagnosed from 2000 to 2007. A reference cohort of 58,760 persons without PLA (controls) was selected from the same database, frequency matched by age, sex, and index year. Both cohorts were followed up until the end of 2009, and incidences of GI cancer were calculated. RESULTS The incidence of GI cancer was 4.30-fold higher among patients with PLA compared with controls (10.8 vs 2.51/1000 person-years). Site-specific analysis showed that the highest incidence of colorectal cancer was among patients with PLA and diabetes mellitus, followed by patients with PLA without diabetes and controls with diabetes (9.58, 5.76, and 1.49/10,000 person-years, respectively). The PLA cohort also had a high risk of small intestine cancer (adjusted hazard ratio [aHR], 12.7; 95% confidence interval [CI], 5.79-27.7) and biliary tract cancer (aHR, 9.56; 95% CI, 6.68-13.7). Their risk of pancreatic cancer (aHR, 2.51; 95% CI, 1.68-3.76) was also significant. However, patients with PLA did not have an increased risk of gastric cancer compared with controls. CONCLUSIONS In a population-based study, we found that the incidence of GI cancer is increased more than 4-fold among patients with PLA compared with controls. PLA might therefore be an indicator of GI cancer. Patients with PLA had the highest incidence of colorectal cancer, followed by cancers of the biliary tract, pancreas, and small intestine.
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Affiliation(s)
- Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ken-Sheng Cheng
- Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Jung-Ta Kao
- Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Wei Chou
- Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Yuan Peng
- Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Wei Lai
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Fung-Chang Sung
- Department of Public Health, China Medical University, Taichung, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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13
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Koo HC, Kim YS, Kim SG, Tae JW, Ko BM, Lee TI, Jeong SW, Jang JY, Kim HS, Lee SH, Kim BS. Should colonoscopy be performed in patients with cryptogenic liver abscess? Clin Res Hepatol Gastroenterol 2013; 37:86-92. [PMID: 22572520 DOI: 10.1016/j.clinre.2012.03.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/17/2012] [Accepted: 03/28/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM The interruption of a mucosal barrier by colon cancer or a polyp can lead to the development of a liver abscess. This study aimed to evaluate the possible contribution of colon cancer to the development of liver abscess and the necessity of colonoscopy in patients presenting with cryptogenic liver abscess. METHODS We reviewed the medical records of 268 patients diagnosed with liver abscess between January 2001 and April 2010. Among cases with no definite cause of liver abscess, differences between patients with and without colon cancer were evaluated in terms of clinical, laboratory, imaging, and microbiological findings. RESULTS Pyogenic liver abscess with no apparent etiology was encountered 163 patients; colonoscopy was performed in 121 of these 163 patients. The tumor diagnosis was confirmed by total colonoscopy in 12/163 (7.4%) patients with adenocarcinoma and 8/163 (4.9%) patients with high-grade dysplasia. Nine patients were diagnosed with stage I, two patients with stage II, and one with stage III disease according to the tumor, nodes, and metastases (TNM) staging system for colorectal cancer. The prevalence of incidental colon cancer in patients with pyogenic liver abscess was significantly higher than that of normal individuals who underwent colonoscopy (0.8%, 90/11,272) at our health care center. CONCLUSIONS Colon cancer may be one etiology of liver abscess. Colonoscopy should be considered in patients with pyogenic liver abscess with not an apparent primary source of infection.
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Affiliation(s)
- Hyun Cheol Koo
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Republic of Korea
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14
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Huang WK, Chang JWC, See LC, Tu HT, Chen JS, Liaw CC, Lin YC, Yang TS. Higher rate of colorectal cancer among patients with pyogenic liver abscess with Klebsiella pneumoniae than those without: an 11-year follow-up study. Colorectal Dis 2012; 14:e794-801. [PMID: 22776247 DOI: 10.1111/j.1463-1318.2012.03174.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Pyogenic liver abscess (PLA) has been reported as an early manifestation of colorectal cancer (CRC) in adults, but few studies have investigated this relationship. It is unclear if patients with Klebsiella pneumoniae PLA are at increased risk of subsequent CRC. Our aims were to estimate the incidence of CRC among patients with PLA and to compare the incidence of CRC between K. pneumoniae PLA and non-K. pneumoniae PLA groups. METHOD We conducted a retrospective study of patients with PLA diagnosed between 2000 and 2009 at a medical centre in northern Taiwan. CRC status and survival status were determined until December 2010. Incidence data from the general population were retrieved from the Taiwan Cancer Registry. Outcome measures were defined as standardized incidence ratio and the incidence rate per 100,000 person-years. RESULTS This study included 2294 patients, of whom 1194 (52%) had K. pneumoniae infection. During the follow-up period, 54 (2.3%) patients were diagnosed with CRC, corresponding to an overall incidence rate of 669.1 (95% CI, 490.7-847.6) per 100,000 person-years. The adjusted hazard ratio of CRC was 2.68 times greater for patients with K. pneumoniae PLA than for those with non-K. pneumoniae PLA (95% CI, 1.40-5.11). CONCLUSION 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.
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Affiliation(s)
- W-K Huang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Medical Foundation Linkou Branch, Taoyuan, Taiwan
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Qu K, Liu C, Wang ZX, Tian F, Wei JC, Tai MH, Zhou L, Meng FD, Wang RT, Xu XS. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia. World J Gastroenterol 2012; 18:2948-55. [PMID: 22736918 PMCID: PMC3380322 DOI: 10.3748/wjg.v18.i23.2948] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/15/2011] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA).
METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by χ2 analysis and continuous variables were evaluated using Student’s t test.
RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneumoniae) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients.
CONCLUSION: K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
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Jeong SW, Jang JY, Lee TH, Kim HG, Hong SW, Park SH, Kim SG, Cheon YK, Kim YS, Cho YD, Kim JO, Kim BS, Lee EJ, Kim TH. Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol 2012; 27:248-55. [PMID: 21777280 DOI: 10.1111/j.1440-1746.2011.06851.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Colonic mucosal defects might be a route for bacterial invasion into the portal system, with subsequent hematogenous spread to the liver. We retrospectively investigated the results of colonoscopy and the clinical characteristics of patients with pyogenic liver abscess of colonic origin. METHODS A total of 230 consecutive patients with pyogenic liver abscess were reviewed between 2003 and 2010. The 230 patients were categorized into three groups (pancreatobiliary [n = 135], cryptogenic [n = 81], and others [n = 14]). Of the 81 cryptogenic patients, 37 (45.7%) underwent colonoscopy. Colonic lesions with mucosal defects were considered colonic causes of abscess. RESULTS In the 37 colonoscopic investigations, colon cancer was found in six patients (16.2%), laterally-spreading tumor (LST) in two patients (5.4%), multiple colon ulcers in one patient (2.7%), colon polyps in 17 patients (45.9%), and diverticula in four patients (10.8%). Nine (11%) of 81 cryptogenic abscesses were therefore reclassified as being of colonic origin (colon cancer = 6, LST = 2, ulcer = 1). Three cases were stage III colon cancer, and the others were stage I. Two LST were high-grade dysplasia. The percentage of patients with Klebsiella pneumoniae (K. pneumoniae) and diabetes mellitus (DM) of colonic origin was 66.7%, which was significantly higher than the 8.6% for other causes (P < 0.001). CONCLUSIONS Of the 37 patients with cryptogenic pyogenic liver abscess who underwent colonoscopy, nine (24.3%) were diagnosed with a colonic cause. Colonoscopy should be considered for the detection of hidden colonic malignant lesions in patients with cryptogenic pyogenic liver abscess, especially for patients with K. pneumoniae and DM.
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Affiliation(s)
- Soung Won Jeong
- Institute for Digestive Research and Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
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Hsu WH, Yu FJ, Chuang CH, Chen CF, Lee CT, Lu CY. Occult colon cancer in a patient with diabetes and recurrent Klebsiella pneumoniae liver abscess. Kaohsiung J Med Sci 2009; 25:98-103. [PMID: 19321414 DOI: 10.1016/s1607-551x(09)70048-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Klebsiella pneumoniae (Kp) is a well-known leading cause of liver abscess in patients with diabetes, but recurrent Kp liver abscess in such patients within a period of time is seldom seen. Here, we report a patient with diabetes who experienced three episodes of Kp liver abscess within 1 year. The patient was subsequently diagnosed to have an occult sigmoid cancer. The liver abscess did not recur after resection of the colonic tumor. Occult sigmoid colonic cancer may have played an important role in the recurrent Kp liver abscess in our case. Therefore, further investigation of gastrointestinal malignancies, particularly of the colonic tract, is necessary in patients with diabetes and Kp liver abscess.
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Affiliation(s)
- Wen-Hung Hsu
- Department of Internal Medicine, Division of Gastroenterology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Yen HH, Chen YY. Polypectomy leading to the resolution of a liver abscess. Gastrointest Endosc 2009; 69:191. [PMID: 19111710 DOI: 10.1016/j.gie.2008.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 05/05/2008] [Indexed: 12/10/2022]
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Cerwenka H. Pyogenic liver abscess and silent pathologies of the digestive tract. Gastroenterol Hepatol (N Y) 2008; 4:819-820. [PMID: 21960905 PMCID: PMC3104392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Herwig Cerwenka
- Department of Visceral Surgery, Medical University of Graz, Austria
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Kumar A, Artifon EL, Siegel C, Halwan B. Gastrointestinal stromal tumor in association with pyogenic liver abscess. Gastroenterol Hepatol (N Y) 2008; 4:818-819. [PMID: 21960904 PMCID: PMC3104391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Atul Kumar
- Northport VA Medical Center and Stony Brook University, Stony Brook, New York
| | | | - Cory Siegel
- Northport VA Medical Center and Stony Brook University, Stony Brook, New York
| | - Bhawna Halwan
- State University of New York–Downstate University Medical Center, Brooklyn, New York
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Gross RG, Reiter B, Korsten MA. Pyogenic liver abscess complicating colonoscopic polypectomy. Gastrointest Endosc 2008; 67:767-8. [PMID: 18155212 DOI: 10.1016/j.gie.2007.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/18/2007] [Indexed: 01/06/2023]
Affiliation(s)
- Rebekah G Gross
- Division of Gastroenterology, Mount Sinai School of Medicine, New York, New York 10029, USA
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Corchado Berjano C, Vinagre Rodríguez G, Guiberteau Sánchez A, Romero Herrera G, Vázquez Labrador JM, Aguilera Musso D, Sánchez Risco P, Montero Alvarez JL. [Liver abscesses due to Gemella morbillorum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:507-8. [PMID: 17949620 DOI: 10.1157/13110498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ruiz-Hernández JJ, León-Mazorra M, Conde-Martel A, Marchena-Gómez J, Hemmersbach-Miller M, Betancor-León P. Pyogenic liver abscesses: mortality-related factors. Eur J Gastroenterol Hepatol 2007; 19:853-8. [PMID: 17873608 DOI: 10.1097/meg.0b013e3282eeb53b] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
GOAL To analyse the characteristics and mortality-related factors in a series of patients hospitalized for pyogenic liver abscess (PLA). BACKGROUND Pyogenic liver abscesses are infrequent but potentially life threatening. Factors related to mortality have been less studied. STUDY The medical records of 84 patients, 56 men and 28 women, mean age of 64.4 years (SD: 14) who were hospitalized between 1992 and 2005 owing to a PLA were reviewed. The past medical history, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatment, complications and mortality were recorded. Factors related to complications and mortality were analysed. RESULTS One or more bacteria were isolated in 65 patients (77.4%), being Streptococcus spp. (40.5%), Escherichia coli (27.4%), Klebsiella spp. (14.3%) and anaerobics (17.9%) the most frequent isolates. Complications developed in 60.7% of the cases, the most common one being a right pleural effusion (34.5%). Mortality rate was 19% (95% confidence interval: 10-28%). Mortality was associated with age (P=0.005), a previous history of coronary heart disease (P=0.016), absence of fever (P=0.001), development of sepsis and/or septic shock (P<0.001), raise of bilirubin levels (P=0.004), a biliary (P=0.035), or cryptogenetic origin (P=0.039), infection owing to E. coli (P=0.01) or to Candida (P=0.009) and development of pneumonia (P<0.001). Logistic regression revealed sepsis and/or septic shock as an independent risk factor for mortality. CONCLUSIONS Mortality associated with PLA is high. The main risk factor for mortality is the development of sepsis and/or septic shock.
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Affiliation(s)
- José Juan Ruiz-Hernández
- Department of Internal Medicine, University Hospital of Gran Canaria Dr Negrín, Las Palmas, Gran Canaria, Spain
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