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Published on: September 3, 2021
Liver abscess as a first manifestation of colonic tumor
N Camargo Schneider1, N Coelho2, P Dutra1
1Hospital mãe de deus, Porto Alegre, Brazil.
Introduction:
Male, 72-year-old, morbidly obese, diabetic, admitted for abdominal pain, prostration and fever that started last 3 days. Abdominal ultrasound and abdominal computed tomography scan showed liver injury in the transition of V and VI segments measuring 8.4 cm. Due to the possibility of liver abscess, initiate empirical antibiotic therapy with ampicillin and sulbactam and metronidazole and performed ultrasound-guided percutaneous drainage of liver injury. Negative for malignant cells, with the presence of leukocytes and negative culture. After 2 weeks of treatment, take control image without changing the lesion dimension. New percutaneous drainage with the same results. We opted for performing endoscopic ultrasound (EUS) with fine-needle aspiration (FNA). FNA pathology: Moderately differentiated adenocarcinoma. Immunohistochemistry suggestive of metastasis of the lower gastrointestinal tract. Due this finding, realized colonoscopy, which revealed a vegetating lesion with central ulceration, bleeding, filling almost the entire cecum. Patient was referred for surgical resection of the bowel tumor, which showed moderately differentiated adenocarcinoma infiltrating vegetative and possibly originated from villous adenoma with high-grade dysplasia.
Discussion:
The finding of metastatic liver abscess of colonic neoplasia is not common. In most cases, the material from the abscess drainage allows the diagnosis, but in this case, even after two ultrasound-guided percutaneous drainage was not obtained conclusive bacteriological or histopathological. Opted for new puncture through EUS, which allowed definitive diagnosis of the condition.
Conclusion:
Metastatic colon neoplasm should be considered in cases of differential diagnosis of liver abscess.
Insights
Metastatic colon cancer can mimic a liver abscess. Repeated drainage procedures failed to diagnose this case, highlighting the utility of endoscopic ultrasound-guided fine-needle aspiration for definitive diagnosis.
Area of Science:
- Gastroenterology
- Oncology
- Radiology
Background:
- A 72-year-old male presented with symptoms suggestive of liver abscess.
- Initial imaging revealed a large liver lesion, prompting empirical antibiotic treatment and ultrasound-guided drainage.
- Repeated drainage attempts were inconclusive, necessitating further investigation.
Purpose of the Study:
- To investigate the diagnostic utility of endoscopic ultrasound-guided fine-needle aspiration in a challenging liver abscess case.
- To determine the etiology of a liver lesion initially suspected to be an abscess.
Main Methods:
- Ultrasound-guided percutaneous liver drainage.
- Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA).
- Colonoscopy and surgical resection of a colonic tumor.
Main Results:
- Initial liver drainage yielded no conclusive bacteriological or histopathological results.
- EUS-FNA diagnosed moderately differentiated adenocarcinoma, suggestive of metastasis from the lower gastrointestinal tract.
- Colonoscopy identified a cecal tumor, confirmed as adenocarcinoma post-resection.
Conclusions:
- Metastatic colonic neoplasm can present as a liver abscess, posing a diagnostic challenge.
- EUS-FNA is a valuable tool for diagnosing liver lesions when conventional methods fail.
- Colonic neoplasm should be considered in the differential diagnosis of liver abscesses.
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