PYOGENIC LIVER-ABSCESS - WARNING INDICATOR OF SILENT COLONIC-CANCER -REPORT OF A CASE AND REVIEW OF THE LITERATURE

PURPOSE: Carcinoma of the colon, manifested clinically as an enterococ cal hepatic abscess, in the absence of liver metastases, is very uncom mon. However, having treated a patient with such a condition, we would like to draw the attention of surgeons to this possibility. Most repo rts describe secondary infections of hepatic metastases only in patien ts with a known malignancy. However, increased awareness of colonic ca ncer as an underlying cause of pyogenic liver abscesses will afford ea rlier diagnosis and treatment. METHODS: The case was analyzed for hist ory, presentation, laboratory data, radiologic studies, and bacteriolo gy. RESULTS: A 66-year-old woman presented with abdominal pain, fever, and chills. Imaging scans revealed a solitary liver abscess, which wa s successfully treated with percutaneous drainage and broad-spectrum i ntravenous antibiotics. Pus cultures grew Streptococcus faecalis. A se arch for the underlying cause led to the discovery of an adenocarcinom a of the sigmoid colon. CONCLUSIONS: An aggressive search for the unde rlying cause of pyogenic liver abscesses should be an integral part of the definitive treatment of this disease. After prevailing etiologies have been excluded, silent colonic cancer should be considered.