The Development of a Liver Abscess after Screening Colonoscopy: A Calculated Risk?

Abstract

We present the case of a patient who developed a liver abscess following screening colonoscopy. A colorectal screening program was introduced in the Netherlands in 2014 in order to reduce mortality from colorectal cancer. The patient in this report, a 63-year-old man with no significant medical history, underwent polypectomy of two polyps. Four days afterwards he presented to our emergency department with fever, nausea and vomiting. He was diagnosed with a Klebsiella pneumoniae liver abscess and was successfully treated with antibiotics for 6 weeks. This case highlights one of the risks of screening colonoscopy. Given the high number of colonoscopies due to the colorectal screening programs, we should be aware of complications in this mostly asymptomatic group of patients. LEARNING POINTS• Screening colonoscopy is a potential risk factor for Klebsiella pneumoniae liver abscess.• It is thought that microperforations during colonoscopy could lead to bacterial invasion causing a pyogenic liver abscess.• We expect the numbers of complications, including pyogenic liver abscess, to grow due to the increase in population-based screening programs for colorectal carcinoma. KEYWORDS (Pyogenic) liver abscess, Klebsiella pneumoniae, colonoscopy, screening CASE DESCRIPTIONA 63-year-old man was scheduled for colorectal screening because of his age. He had atrial fibrillation, an inguinal hernia and a herniated nucleus pulposus. As an immunoassay faecal occult blood test (iFOBT) showed occult blood in his faeces, he underwent a screening colonoscopy. The colonoscopy revealed diverticulosis and three polyps, two of which were removed by polypectomy. The first polyp was located in the caecum and the second in the descending colon. The third polyp (Fig. 1), located in the hepatic flexure, was left in situ for endomucosal resection (EMR) in the near future. The patient returned home after colonoscopy. However, 4 days later he presented to the emergency department with fever, nausea and vomiting. His blood results showed a high C-reactive protein (251 mg/l, normal range 0-10 mg/l) and elevated liver enzymes (ALAT 169 IU/l, normal range 0-35 IU/l). Sonography of the abdomen showed a mass measuring 5.7×4.6 cm in the right liver lobe. Computed tomography (CT) of the abdomen confirmed this liver abscess but showed no other abnormalities (Fig. 2).

Intra-hospital acquisition of colonization and infection by Klebsiella pneumoniae strains producing carbapenemases and carriage evolution: A longitudinal analysis in an Italian teaching hospital from January 2017 to August 2019

“…First, the patient can be responsible for CPKP transmission via non-invasive procedures (i.e. colonoscope and gastroscope-associated infection) (England et al, 2016;Bac and Bac, 2017) that are frequently performed in out-patients. The medical personnel should be informed and they should apply cleaning and disinfection protocols to avoid infections due to the instruments in other subjects.…”