Institute for Digestive Research and Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea.
J Gastroenterol Hepatol. 2012 Feb;27(2):248-55. doi: 10.1111/j.1440-1746.2011.06851.x.
Colonic mucosal defects might be a route for bacterial invasion into the portal system, with subsequent hematogenous spread to the liver. We retrospectively investigated the results of colonoscopy and the clinical characteristics of patients with pyogenic liver abscess of colonic origin.
A total of 230 consecutive patients with pyogenic liver abscess were reviewed between 2003 and 2010. The 230 patients were categorized into three groups (pancreatobiliary [n = 135], cryptogenic [n = 81], and others [n = 14]). Of the 81 cryptogenic patients, 37 (45.7%) underwent colonoscopy. Colonic lesions with mucosal defects were considered colonic causes of abscess.
In the 37 colonoscopic investigations, colon cancer was found in six patients (16.2%), laterally-spreading tumor (LST) in two patients (5.4%), multiple colon ulcers in one patient (2.7%), colon polyps in 17 patients (45.9%), and diverticula in four patients (10.8%). Nine (11%) of 81 cryptogenic abscesses were therefore reclassified as being of colonic origin (colon cancer = 6, LST = 2, ulcer = 1). Three cases were stage III colon cancer, and the others were stage I. Two LST were high-grade dysplasia. The percentage of patients with Klebsiella pneumoniae (K. pneumoniae) and diabetes mellitus (DM) of colonic origin was 66.7%, which was significantly higher than the 8.6% for other causes (P < 0.001).
Of the 37 patients with cryptogenic pyogenic liver abscess who underwent colonoscopy, nine (24.3%) were diagnosed with a colonic cause. Colonoscopy should be considered for the detection of hidden colonic malignant lesions in patients with cryptogenic pyogenic liver abscess, especially for patients with K. pneumoniae and DM.
结肠黏膜缺损可能是细菌入侵门静脉系统的途径，随后通过血液播散至肝脏。我们回顾性调查了结肠来源化脓性肝脓肿患者的结肠镜检查结果和临床特征。
2003 年至 2010 年期间共回顾性分析了 230 例连续化脓性肝脓肿患者。将 230 例患者分为三组（胰胆管源性[135 例]、隐源性[81 例]和其他[14 例]）。在 81 例隐源性患者中，有 37 例行结肠镜检查。有黏膜缺损的结肠病变被认为是脓肿的结肠原因。
在 37 例结肠镜检查中，发现 6 例（16.2%）结肠癌、2 例（5.4%）侧向扩展型肿瘤（LST）、1 例（2.7%）多发结肠溃疡、17 例（45.9%）结肠息肉和 4 例（10.8%）憩室。因此，81 例隐源性脓肿中有 9 例（11%）被重新归类为结肠来源（结肠癌=6，LST=2，溃疡=1）。3 例为Ⅲ期结肠癌，其余为Ⅰ期。2 例 LST 为高级别异型增生。结肠来源的克雷伯氏肺炎杆菌（K. pneumoniae）和糖尿病（DM）患者的比例为 66.7%，明显高于其他原因的 8.6%（P<0.001）。
在接受结肠镜检查的 37 例隐源性化脓性肝脓肿患者中，有 9 例（24.3%）被诊断为结肠原因。对于隐源性化脓性肝脓肿患者，特别是对于克雷伯氏肺炎杆菌和糖尿病患者，应考虑行结肠镜检查以发现隐匿性结肠恶性病变。
