Colonic Diverticulitis Complicated by Liver Abscess: Case Series and Review of Literature

Abstract

Aim: Evaluate patients with colonic diverticulitis complicated by liver abscesses at a single center and provide review of literature.Methods: Patients with colonic diverticulitis and liver abscess were identified via an administrative database and imaging search engine at Cedars Sinai Medical Center (CSMC). Clinical manifestations, laboratory and imaging findings and treatment strategies were assessed.Results: We identified 10 patients with a median age of 59 and a 7:3 male: female ratio. The top presenting signs and symptoms were: fever (90%), malaise (70%), anorexia (60%), nausea (40%), and right upper quadrant abdominal pain (30%). Mean white blood cell count was 22.4 1000/UL, total bilirubin 2.59 mg/DL, and alkaline phosphatase 206.6 IU/L. Of the reported liver abscess cultures, 5 patients grew a single organism and 2 had multiple organisms. Most common bacteria genus was Streptococcus (n=4). Five patients had right hepatic abscesses, 3 had bilobar, and 2 had left hepatic abscesses. Four patients had locally complicated diverticulitis: 2 with paracolonic abscess and 2 with purulent peritonitis. Nine patients had CT-guided drainage of liver abscess, while 2 needed surgical drainage of liver abscess (one required both). Five patients had colectomy: 1 emergently and 4 electively. Two patients who did not have colectomy had recurrent diverticulitis, and underwent colectomy following recurrence.Conclusion: Majority of patients with diverticulitis with liver abscess were males presenting with fever, and leukocytosis. Most had right liver lobe abscesses and most underwent colectomies. Diverticulitis with liver abscess is likely best treated as locally complicated disease and should undergo colectomy.