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Cryptogenic pyogenic liver abscess as the herald of colon cancer.
MedLine Citation:
PMID:  21777280     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 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 [pancreato-biliary (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 LSTs 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 8.6% of other causes (p < 0.001). Conclusions: Of 37 patients with cryptogenic pyogenic liver abscess who underwent colonoscopy, nine (24.3%) were diagnosed with a colonic cause. Colonoscopy should be considered for detection of hidden colonic malignant lesions in patients with cryptogenic pyogenic liver abscess, especially for patients with K. pneumoniae and DM.
Authors:
Soung Won Jeong; Jae Young Jang; Tae Hee Lee; Hyun Gun Kim; Sung Wook Hong; Seung Hoon Park; Sang Gyune Kim; Young Koog Cheon; Young Seok Kim; Young Deok Cho; Jin-Oh Kim; Boo Sung Kim; Eun Jung Lee; Tae Hyong Kim
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-20
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  -     ISSN:  1440-1746     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
Affiliation:
Institute for Digestive Research and Digestive Disease Center, Division of Gastroenterology, Department of Internal medicine, Soonchunhyang University Hospital, Seoul, Korea, Division of Infectious diseases, Department of Internal medicine, Soonchunhyang University Hospital, Seoul, Korea.
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