Hepatogastric fistula following amoebic liver abscess: an extremely rare and difficult situation

Hepatogastric fistula: A rare complication of liver abscess

“…Such a fistula has also been described following transarterial embolization, radiotherapy for hepatocellular carcinoma, percutaneous radiofrequency thermal ablation of hepatocellular carcinoma, pyogenic liver abscess, iatrogenic injury of the stomach, percutaneous catheter drainage of liver abscess, metal stent placement to decompress an obstructed biliary system in case of benign or malignant biliary obstruction, or by direct infiltration of stomach by hepatocellular carcinoma. [8] Rupture of liver abscess into the stomach may present with persistent severe abdominal pain, [7,9] recurrent [10] or bilious vomiting, [8] or hematemesis [6] as in our case. Hematemesis in these cases is usually due to tearing of the mucosal surface.…”

“…[12] There is no clear consensus regarding the management of hepatogastric fistula due to rarity of the condition and variable presentation. [9,10] Conservative management includes keeping patient nil per oral, percutaneous drainage of liver abscess, antibiotic therapy, proton pump inhibitors, and decompression of the stomach. [13] A nasojejunal tube may be passed distally for initial feeding purpose or alternatively a distal feeding jejunostomy can be made.…”

Hepatogastric fistula: a rare complication of pyogenic liver abscess

“…Operative strategies include open drainage of abscess with excision of fistula and en bloc resection of the involved portions of the stomach and the liver. Operative strategies are recommended in hepatogastric fistula with HCC or if fistula fails to heal by conservative management 1. The main cause of failure of expectant management in our patient was high output internal biliary fistula.…”

“…There are no guidelines for the diagnosis and management of this condition 1. We report a rare case of hepatogastric fistula as a complication of pyogenic liver abscess.…”

Gastrointestinal fistulization in amebic liver abscess

“…Hepatico-gastrointestinal lumen perforations are very rare in children; only a few cases are reported [6]. Various treatment modalities are suggested, including major surgeries [7]. Ideal approach would be to individualize the therapeutic options depending upon the physiological status of the patient and expertise of treating center.…”