Question

Articles on role of colonoscopy in liver abscess patients

Answer 1

Although an association between pyogenic liver abscess and colon cancer has been suggested, liver abscess as a presenting sign of occult colorectal cancer has rarely been reported [1,2]. Destruction of the mucosal barrier by a colorectal neoplasm, followed by bacterial translocation into the portal venous system, might contribute to the formation of liver abscess [2]. We describe a case of recurrent pyogenic liver abscess at short intervals as the first manifestation of colorectal cancer in the absence of liver metastases. A healthy 66-year-old male visited the emergency room because of right upper abdominal pain associated with fever and chills over the past 5 days. He reported no history of cigarette smoking and alcohol consumption. Physical examination revealed tachycardia (pulse rate, 88 beats/min), a body temperature of 38.7°C, and tenderness of the right upper abdomen. Laboratory tests showed a white blood cell (WBC) count of 11,460/μL, with 83.9% neutrophils, and a hemoglobin level of 14.4 g/dL. The blood chemistry profile was as follows: fasting glucose, 106 mg/dL; total protein, 5.9 g/dL; albumin, 2.9 g/dL; total bilirubin, 0.9 mg/dL; aspartate aminotransferase, 107 U/L; and alanine aminotransferase, 195 U/L; alkaline phosphatase, 674 U/L; gamma-glutamyl transferase, 321 U/L. The C-reactive protein level was 12.9 mg/dL (normal range < 0.3). Serologic tests for hepatitis B and C were negative. Serologic tests for tumor markers revealed normal levels of α-fetoprotein (2.7 ng/mL), carbohydrate antigen 19-9 (9.1 U/mL), and carcinoembryonic antigen (0.7 ng/mL).