Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia

Qu, Kai; Liu, Chang; Wang, Zhixin; Tian, Feng; Wei, Ji-Chao; Tai, Ming-Hui; Zhou, Lei; Fang, Meng; Wang, Ruitao; Xu, Xiayu

doi:10.3748/wjg.v18.i23.2948

Cited by 67 publications

(69 citation statements)

References 34 publications

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“…The incidence of postoperative local recurrence in the pelvic cavity is low (5)(6)(7). However, it is not uncommon for colon cancer to cause an abscess in a distant organ (8)(9)(10)(11)(12)(13)(14)(15)(16). Regarding the pathogenesis of systemic abscesses associated with colorectal cancer, small abscesses may form around the tumor or bacterial invasion may occur secondary to damage to the intestinal wall, which is followed by hematogenous spread (13).…”

Section: Introductionmentioning

confidence: 99%

Early rectal cancer accompanied by multiple systemic abscesses: A case report

et al. 2015

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Abstract.A 70-year-old man undergoing treatment for diabetes presented with a cough and pyrexia that has lasted one week. Laboratory tests demonstrated evidence of inflammation. The patient was hospitalized and antibiotic treatment was initiated, but the condition of the patient did not improve. After 2 weeks, computerized tomography scanning demonstrated the presence of multiple small nodules in the lungs and a liver abscess. The patient also developed neck pain and numbness of the upper extremities and was then transferred to Tokai University Hachioji Hospital (Tokyo, Japan). Percutaneous transhepatic drainage (PTD) of the liver abscess was performed and antibiotic treatment was initiated. Detailed examination revealed there was pyogenic spondylitis of the cervical spine, therefore abscess drainage and an anterior cervical spinal fusion were performed. Culture of each lesion resulted in Klebsiella pneumoniae growth. While continuing antibiotic treatment and rehabilitation, the gastrointestinal tract was investigated and evidence of early rectal cancer was observed. The pulmonary nodules disappeared during treatment, indicating that these were multiple lung abscesses. Four weeks following abscess drainage and anterior cervical spinal fusion, lower anterior resection was performed. The present case report describes a patient who developed multiple abscesses associated with early rectal cancer and discusses the case with reference to the literature. IntroductionAt present, the global incidence of colorectal cancer is increasing, which is considered to be a result of westernization of the diet and obesity (1-4). The main symptoms are rectal bleeding with or without progressive anemia and weight loss. The recommended treatment for stage I colorectal cancer is surgical resection combined with lymph node dissection (5).The 5-year survival rate of patients following resection of stage I colorectal cancer is 90-95%, with postoperative distant metastasis/recurrence occuring in 5-10% of patients (5). The incidence of postoperative local recurrence in the pelvic cavity is low (5-7). However, it is not uncommon for colon cancer to cause an abscess in a distant organ (8-16). Regarding the pathogenesis of systemic abscesses associated with colorectal cancer, small abscesses may form around the tumor or bacterial invasion may occur secondary to damage to the intestinal wall, which is followed by hematogenous spread (13). The development of abscesses may be promoted by the impaired immunity of tumor-bearing patients and associated diseases, such as diabetes, may also affect immunity (12,13). In the literature, five cases of colorectal cancer in which liver abscesses were the chief complaint have been reported. Of these five cases, 1 early cancer patient (8) and 3 advanced cancer patients exhibited liver abscesses alone (9,10,13) and 1 advanced cancer patient exhibited multiple systemic abscesses (12). Fever was the main symptom in all cases, with weight loss, malaise and nausea/vomiting also observed (8)(9)(10)12,13). In addit...

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Section: Introductionmentioning

confidence: 99%

Early rectal cancer accompanied by multiple systemic abscesses: A case report

et al. 2015

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“…Destruction of colonic mucosal barrier and bacterial translocation into the portal system with haematogenous spread to the liver have been postulated. (16) In Jeong et al's study conducted in South Korea, among 37 patients with cryptogenic liver abscess who underwent optical colonoscopy between 2003 and 2010, 8 (22%) patients had colon cancer. (17) It is therefore important to screen for CRC in patients with cryptogenic liver abscess, especially in diabetics and those with K. pneumoniae.…”

Section: Association Of Crc With Liver Abscessmentioning

confidence: 99%

“…From 1960 to 2011, a total of 96 documented cases of CRCrelated cryptogenic liver abscess were reported worldwide and in the Eastern Asian countries; the numbers have increased by 2-4 times in the past few decades. (16) The male gender is more often affected and the mean age of patients is 64 years. (16) A high percentage of these patients have diabetes mellitus and Klebsiella pneumoniae (K. pneumoniae) of colonic origin.…”

Section: Association Of Crc With Liver Abscessmentioning

confidence: 99%

“…(16) The male gender is more often affected and the mean age of patients is 64 years. (16) A high percentage of these patients have diabetes mellitus and Klebsiella pneumoniae (K. pneumoniae) of colonic origin. (16,17) The most commonly involved segment is the sigmoid colon, followed by the rectum.…”

Section: Association Of Crc With Liver Abscessmentioning

confidence: 99%

“…(16) A high percentage of these patients have diabetes mellitus and Klebsiella pneumoniae (K. pneumoniae) of colonic origin. (16,17) The most commonly involved segment is the sigmoid colon, followed by the rectum. Destruction of colonic mucosal barrier and bacterial translocation into the portal system with haematogenous spread to the liver have been postulated.…”

Section: Association Of Crc With Liver Abscessmentioning

confidence: 99%

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Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Lee¹,

Poh²

2015

smedj

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Colorectal carcinoma is a common lethal disease with signs and symptoms that may be nonspecific. Computed tomography (CT) of the abdomen and pelvis with or without contrast is frequently performed for various general abdominal complaints, but unlike CT colonography, the large bowel may not be optimally prepared for evaluation. As such, careful and diligent assessment of the non-prepared colon in all CT images of the abdomen and pelvis is important, as it ensures that incidental colorectal malignancy is not missed, especially in older patients. This article gives an overview of multidetector CT imaging signs and subtle clues to aid in the diagnosis of colorectal carcinoma, as well as their pitfalls.

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Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess

Suzuki,

Kidder,

Tanaka

et al. 2023

JAMA Netw Open

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ImportanceColorectal cancer (CRC) can compromise the mucosal barrier and subsequently allow a route for bacterial invasion into the portal system or systemic circulation. Despite preliminary data suggesting that patients who experienced pyogenic liver abscess (PLA) have higher CRC incidence rates, data from outside the Southeast Asian population are sparse.ObjectiveTo investigate whether there is an association between PLA and the subsequent incidence of diagnosed CRC using the Veterans Health Administration (VHA) cohort.Design, Setting, and ParticipantsA patient-level matched retrospective cohort study was conducted at 127 VHA hospitals across the US from January 1, 2003, to December 31, 2020. Patients were followed up to 10 years from PLA diagnosis. Data analysis was performed from April 14, 2002, to October 31, 2023. All patients who were admitted to VHA hospitals with a diagnosis of PLA were included. For each patient with PLA, up to 3 controls without diagnosis of PLA, matching age, sex, and health care facility, were selected.ExposurePyogenic liver abscess.Main Outcomes and MeasuresThe primary outcome was CRC diagnosis during the follow-up period. A multivariable Fine-Gray subdistribution regression model with time-dependent coefficient was used to estimate the time-varying hazard ratio (HR) of CRC incidence while accounting for mortality as a competing event.ResultsA total of 8286 patients with PLA (male, 96.5%; mean [SD] age, 65.8 [11.9] years) and 23 201 patient-level matched controls (male, 96.3%; mean age, 65.3 [11.7] years) were included. A diagnosis of CRC was found in a significantly higher proportion of patients with PLA compared with controls (1.9% [159 of 8286] vs 0.8% [196 of 23 201]; P &lt; .001). The incidence of CRC was significantly higher among patients with PLA during the first 3 years from PLA diagnosis (HR, 3.64; 95% CI, 2.70-4.91 at 0.5 years; HR, 2.51; 95% CI, 1.93-3.26 at 1 year; HR, 1.74; 95% CI, 1.33-2.28 at 2 years; and HR, 1.41; 95% CI, 1.05-1.89 at 3 years), but not significant after 3 years. This association was not observed among patients whose PLA was likely secondary to cholangitis or cholecystitis (HR, 1.78; 95% CI, 0.89-3.56 at 0.5 years).Conclusions and RelevanceIn this patient-level matched retrospective cohort study, a significantly higher incidence of CRC was observed up to 3 years from PLA diagnosis. The findings suggest that offering CRC screening for patients with cryptogenic PLA may be useful, especially patients who have not been screened according to guidelines.

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Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia

Cited by 67 publications

References 34 publications

Early rectal cancer accompanied by multiple systemic abscesses: A case report

Early rectal cancer accompanied by multiple systemic abscesses: A case report

Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess

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