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Appendicitis with direct fistulation into the liver: a forgotten cause of pyogenic liver abscess

Tom Armstrong1, Sam Dluzewski1, Dominic Yu2

  • 1Radiology Registrar, Royal Free Hospital, London, UK.

BJR Case Reports
|December 10, 2020
PubMed

Insights

Pyogenic liver abscesses, often from bloodstream infections, are rarely caused by direct spread from appendicitis. Modern antibiotics have made this rare transmission route virtually nonexistent.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Pyogenic liver abscess (PLA) is typically secondary to biliary or hematogenous spread.
  • Appendicitis can lead to PLA through hematogenous spread via the mesenteric vasculature.

Observation:

  • Direct intra-abdominal spread of infection from appendicitis to the liver, causing PLA, is exceptionally rare.
  • Historical reports exist, but antibiotic therapy has rendered this transmission route almost obsolete.

Findings:

  • A literature review of over 900 cases revealed no documented instances of PLA resulting from direct intra-abdominal spread of acute appendicitis.
  • This highlights the effectiveness of antibiotic treatment in preventing such complications.

Implications:

  • The findings underscore the diminished risk of PLA from direct appendiceal spread due to antibiotics.
  • Clinicians should prioritize standard PLA etiologies and recognize the rarity of this specific pathway.

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