Hepato-Colonic Fistula: Rare Complication of Pyogenic Liver Abscess.

Background/Aims A pyogenic liver abscess is a suppurating infection of the hepatic parenchyma that occurs due to biliary tract diseases, intra-abdominal infections, or cryptogenic causes. There have been a few reported cases of hepato-gastric or hepato-biliary fistula as its complication, however, we have not found any case of hepato-colonic fistula based on available literature. We present an extremely rare case of a hepato-colonic fistula as a complication of pyogenic liver abscess. Methods Case report Results A 53-year-old man with a high-grade fever was referred to our tertiary teaching hospital for one week. He had a history of multiple gallbladder/common bile duct stones managed with cholecystectomy/choledochoduodenostomy and endoscopic stone removal, and three episodes of liver abscess during past 25 years. The body temperature was 39.3℃; blood pressure was 87/59mmHg. The complete blood count showed leukocytosis with absolute neutrophilia (14,440 with 82.4% of neutrophil). C-reactive protein was 218.4 mg/L. A computed tomography scan of the abdomen (Figure 1) confirmed the presence of a 6.2 cm liver abscess occupying segment 5/6 with abutting colonic hepatic flexure. Percutaneous catheter drainage (PCD) of the liver abscess was performed, and communication of liver abscess with a colon hepatic flexure was verified on tubography. Subsequent culture results of pus identified Enterococcus faecalisand Enterobacter cloacae, and ceftriaxone and metronidazole were intravenously given. After stabilization of the patient with PCD and antibiotics therapy, wedge resection of the liver and right hemicolectomy was performed, and histologic examination showed liver abscess with surrounding fibrosis, intrahepatic bile duct dilation with periductal inflammation, and fistulous tract in the colon with transmural inflammation and marked subserosal fibrosis. The patient recovered and was discharged without complication 3 weeks after surgical treatment. Conclusion Hepato-colonic fistula should be considered as a serious complication of liver abscess despite its extreme rarity. [ABSTRACT FROM AUTHOR]