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• W147331427 abstract "Successful management of hepatic abscess remains a clinical challenge. The mechanisms by which bacteria can form pyogenic liver abscess include ascending biliary infection; portal bacteremia; septicemia; direct extension from intraperitoneal infection; direct trauma to the liver; and secondary infection of metastatic cancer.1The diagnosis and treatment of underlying disease is crucial for the prognosis of hepatic abscess; in particular, concomitant pathologies of the biliary tract are common and must be treated.2,3 In a considerable number of patients, the underlying cause of the abscess remains unclear. In a recent study my colleagues and I conducted,4 the proportion of cryptogenic abscesses in patients with pyogenic liver abscesses was 22%. As stated by Kumar and associates,5 the nature of the isolate from liver aspirate and blood is indicative of the source of the infective agent (biliary tree, peritoneum, or blood) and may offer a hint at the etiology. However, bacteriology is negative in some patients (27% in our study), which may be explained, at least partly, by antibiotic pretreatment. Therefore, the next question is how to determine the management of patients in whom the etiology of liver abscess cannot be elucidated.In the past, various researchers have emphasized that, after prevailing causes have been excluded, silent colonic cancer should be considered and these patients should undergo full gastrointestinal evaluation.6–8 On occasion, pyogenic liver abscesses may be caused by infection of hepatic metastases, but they may also be the presenting sign of unsuspected colonic cancer without spreading to the liver.7 Large colonic adenoma has also been reported in association with pyogenic liver abscess, and the potential mechanism may be the same as in colonic cancer: mucosal defects on the colonic lesions may allow a route for bacterial invasion.9 Even if these patients do not have macroscopic intestinal perforation or ulcerations, invading bacteria may find entry through a mucosal barrier break.1Lescut and colleagues have observed bacterial translocation in colonic cancers regardless of Dukes stage and also in the case of in situ carcinoma.10,11 Matsushita and coworkers have reported on a patient with brain, lung, and liver abscesses associated with colon cancer.12 In this patient, untreated diabetes may have contributed to the severity of septicemia; sigmoid cancer was detected 1 month later, and retrospectively, mucosal disruption by the tumor exposing the underlying blood vessels to the fecal flora was considered to be the most likely mechanism of bacteremia.Matsutani and associates13 have described liver abscesses associated with a stromal tumor of the stomach with giant ulceration. In 2007, Kim and colleagues14 reported on a patient with a malignant gastrointestinal stromal tumor (GIST) of the ileum and a liver abscess. This GIST was characterized by central necrosis and a fistula in the ileum; small-bowel series showed contrast material filling into the ileal GIST mass. Surgery found invasion into the sigmoid colon and urinary bladder.In the patient with pyogenic liver abscesses and GIST treated by Kumar and coworkers,5 only minimal disruption of the mucosa overlying the gastric lesion was seen on endoscopy. The described hypotheses of factors potentially contributing to hepatic abscess formation highlight interesting aspects of this topic and open up questions for further investigation of possible mechanisms that are still not fully understood.Pyogenic liver abscesses without obvious etiology should always alert the clinician to silent pathologies of the digestive tract." @default.
• W147331427 created "2016-06-24" @default.
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• W147331427 date "2008-11-01" @default.
• W147331427 modified "2023-09-23" @default.
• W147331427 title "Pyogenic liver abscess and silent pathologies of the digestive tract." @default.
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