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Hepatocolic fistula: a rare presentation of pyogenic liver abscess.

Abstract A 58-year-old man was admitted due to a 4-month history of colicky right upper quadrant pain, intermittent fever, anorexia and weight loss. A contrast-enhanced CT scan of the abdomen showed an encapsulated, peripherally enhancing focus occupying the right liver lobe exhibiting capsular rupture and extension to the walls of the hepatic flexure. He immediately underwent emergency ultrasound-guided percutaneous catheter drainage and cultures of the purulent fluid later revealed Escherichia coli A colonoscopy was then performed which showed a pinpoint opening with draining pus at the hepatic flexure. A fistulogram confirmed a fistulous tract arising from the inferior aspect of the abscess cavity, draining into the posterosuperior aspect of the hepatic flexure. He was started on intravenous antibiotics and after 1 week of decreasing output, a repeat ultrasound showed very minimal residual fluid. The percutaneous catheter drain was then removed after 2 weeks and the patient was discharged improved.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj case reports
Publication Year Start




PMID- 28275025
OWN - NLM
STAT- MEDLINE
DA  - 20170309
DCOM- 20170316
LR  - 20170316
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2017
DP  - 2017 Mar 08
TI  - Hepatocolic fistula: a rare presentation of pyogenic liver abscess.
LID - bcr2016219141 [pii]
LID - 10.1136/bcr-2016-219141 [doi]
AB  - A 58-year-old man was admitted due to a 4-month history of colicky right upper
      quadrant pain, intermittent fever, anorexia and weight loss. A contrast-enhanced 
      CT scan of the abdomen showed an encapsulated, peripherally enhancing focus
      occupying the right liver lobe exhibiting capsular rupture and extension to the
      walls of the hepatic flexure. He immediately underwent emergency
      ultrasound-guided percutaneous catheter drainage and cultures of the purulent
      fluid later revealed Escherichia coli A colonoscopy was then performed which
      showed a pinpoint opening with draining pus at the hepatic flexure. A fistulogram
      confirmed a fistulous tract arising from the inferior aspect of the abscess
      cavity, draining into the posterosuperior aspect of the hepatic flexure. He was
      started on intravenous antibiotics and after 1 week of decreasing output, a
      repeat ultrasound showed very minimal residual fluid. The percutaneous catheter
      drain was then removed after 2 weeks and the patient was discharged improved.
CI  - 2017 BMJ Publishing Group Ltd.
FAU - Timbol, Aeden Bernice G
AU  - Timbol AB
AD  - Section of Gastroenterology, Department of Medicine, Philippine General Hospital,
      University of the Philippines, Manila, Philippines.
FAU - Mondragon, Karen Anjela M
AU  - Mondragon KA
AD  - Section of Gastroenterology, Department of Medicine, Philippine General Hospital,
      University of the Philippines, Manila, Philippines.
FAU - Banez, Virgilio P
AU  - Banez VP
AD  - Section of Gastroenterology, Department of Medicine, Philippine General Hospital,
      University of the Philippines, Manila, Philippines.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170308
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Administration, Intravenous
MH  - Anti-Bacterial Agents/*administration & dosage/therapeutic use
MH  - Biliary Fistula/complications/pathology/*surgery
MH  - Colonoscopy
MH  - Escherichia coli Infections/*diagnosis
MH  - Humans
MH  - Liver
MH  - Liver Abscess, Pyogenic/*diagnosis/surgery
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
EDAT- 2017/03/10 06:00
MHDA- 2017/03/17 06:00
CRDT- 2017/03/10 06:00
AID - bcr-2016-219141 [pii]
AID - 10.1136/bcr-2016-219141 [doi]
PST - epublish
SO  - BMJ Case Rep. 2017 Mar 8;2017. pii: bcr2016219141. doi: 10.1136/bcr-2016-219141.

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