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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. LEARNING POINTS• Screening colonoscopy is a potential risk factor for Klebsiella pneumoniae liver abscess.• It is thought that microperforations during colonoscopy could lead to bacterial invasion causing a pyogenic liver abscess.• We expect the numbers of complications, including pyogenic liver abscess, to grow due to the increase in population-based screening programs for colorectal carcinoma. KEYWORDS (Pyogenic) liver abscess, Klebsiella pneumoniae, colonoscopy, screening CASE DESCRIPTIONA 63-year-old man was scheduled for colorectal screening because of his age. He had atrial fibrillation, an inguinal hernia and a herniated nucleus pulposus. As an immunoassay faecal occult blood test (iFOBT) showed occult blood in his faeces, he underwent a screening colonoscopy. The colonoscopy revealed diverticulosis and three polyps, two of which were removed by polypectomy. The first polyp was located in the caecum and the second in the descending colon. The third polyp (Fig. 1), located in the hepatic flexure, was left in situ for endomucosal resection (EMR) in the near future. The patient returned home after colonoscopy. However, 4 days later he presented to the emergency department with fever, nausea and vomiting. His blood results showed a high C-reactive protein (251 mg/l, normal range 0-10 mg/l) and elevated liver enzymes (ALAT 169 IU/l, normal range 0-35 IU/l). Sonography of the abdomen showed a mass measuring 5.7×4.6 cm in the right liver lobe. Computed tomography (CT) of the abdomen confirmed this liver abscess but showed no other abnormalities (Fig. 2).

hospital stay were lower in HV. The rate of intraoperative incidents was similar in the low-risk stratum, however lower in HV in the moderate-risk and high-risk strata (absolute difference 6.7% and 14.2%; P<0.004). Conclusion: HV had a sixfold higher use of LLR, less conversions, and shorter hospital stay, as compared to a nationwide LMV. Stratification into difficulty scores identified some differences but largely outcomes appeared better for HV in each risk group.