Penetrating Gastric Ulcer Presenting as a Subcapsular Liver Abscess

Abstract

This report describes a subcapsular liver abscess secondary to a penetrating gastric ulcer. The initial read on the CT scan misinterpreted the abscess cavity as an opacified loop of bowel, although it was very conspicuous on a retrospective review. A penetrating gastric ulcer was identified with esophagogastroduodenoscopy and the subcapsular liver abscess was subsequently detected using MRI. Although the conventional treatment of this condition is surgery, successful management was accomplished with a combination of percutaneous drainage, Helicobacter pylori eradication, and acid-suppressive therapy. A review of the literature is provided, including associated cases and the diagnostic modalities used in the evaluation of this condition. This case illustrates how one can arrive at the correct diagnosis with the use of multiple complementary modalities of investigation.

Gastric ulcer penetration into the liver mimicking malignancy on endoscopic ultrasound

“…Penetration of benign gastric ulcers into adjacent organs (liver, pancreas, heart) has previously been described, 1 2 the first case of liver penetration being an autopsy finding reported in 1880.3 In recent reports, hepatic involvement was readily demonstrated by the presence of hepatic tissue on endoscopic biopsies or presented as a subcapsular liver abscess. 4 5 A pattern of extensive inflammatory-fibrotic tissue formation mimicking a pseudotumor, as in the present case, is rare. Its EUS features closely resemble malignancy and clinicians’ awareness is warranted not to misinterpret them in the absence of histology.…”

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

“…On radiological imaging, the connection between the stomach or duodenum and the liver was recorded in eight cases, 10 , 22 , 23 , 30 , 39 , 41 – 43 which were revealed by the observation of the movement of oral contrast or air bubbles between the two organs or fistula formation on computed tomography (CT), ultrasound or magnetic resonance imaging (MRI). Direct observation of an ulcer that penetrated the liver was observed or suspected in three cases, all by CT. 16 , 17 , 36 By ultrasound, the target lesion was observed in two cases.…”

Bile Ductular Proliferation in the Gastric Wall after Gastric Ulcer Penetration into the Liver

“…The hepatic-related complications of a perforated gastric ulcer are liver abscess, upper gastrointestinal hemorrhage, subcap- sular liver abscess, 6 and liver rupture. Kayacetin and Kayacetin 7 reported one case and reviewed 13 others of liver penetration by a peptic ulcer.…”