Hepatogastric fistula as a rare complication of pyogenic liver abscess

Abstract

Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.

Spontaneous Hepatogastric Fistula: A Rare Complication of Amebic Liver Abscess

“…Majority of the case reports describe the development of hepatogastric fistula either at the beginning of the treatment due to large size or after percutaneous drainage was done. 4 In this case, the patient had spontaneous rupture that too, after significant clinical and radiological improvement with a decrease in size on day nine. In the past, spontaneous hepatogastric fistula, as a complication of the liver abscess, has been managed with surgery.…”

“…In the past, spontaneous hepatogastric fistula, as a complication of the liver abscess, has been managed with surgery. 4 Presently spontaneous rupture of liver abscess into pleura or peritoneum is being managed conservatively with or without percutaneous drainage and when required with an endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting in case of internal biliary fistula. 4 Similarly, this case was also managed conservatively without any surgical or radiological intervention with complete resolution of the abscess.…”

Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia

“…Classically, PLA pathogenesis develops because of an ascending bacterial infection acquired via the biliary tract and typically originates from pylephlebitis accompanied by appendicitis and cholangitis owing to biliary tract surgery or gallbladder stones [ 5 , 6 , 8 ]. Hematogenous PLA is acquired from the hepatic portal vein or artery, which occurs because of a mucosal injury owing to colon cancer, colonic diverticulitis, or IBD [ 9 , 10 ].…”

“…The most common causative pathogen of PLA is Klebsiella pneumoniae (KP). KP can invade the liver via many routes, including the biliary tract, hepatic arteries, and portal vein and through direct invasion from an adjacent infected organ [ 4 - 6 ]. Hematogenous PLA is closely associated with colonic mucosal injuries such as colon cancer, intestinal tuberculosis, colonic diverticulitis, and inflammatory bowel disease (IBD) [ 3 , 7 ].…”

“…The most common causative pathogen of PLA is Klebsiella pneumoniae (KP). KP can invade the liver via many routes, including the biliary tract, hepatic arteries, and portal vein and through direct invasion from an adjacent infected organ [4][5][6]. Hematogenous PLA is closely associated with colon-Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation.…”