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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (4) : 434-437     DOI: 10.1007/s11684-011-0157-3
CASE REPORT |
Pyogenic liver abscess as initial presentation in locally advanced right colon cancer invading the liver, gallbladder, and duodenum
Kai Qu1, Chang Liu1(), Aasef M A Mansoor2, Bo Wang1, Jincai Chen3, Liang Yu1, Yi Lv1
1. Department of Hepatobiliary Surgery, the First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an 710061, China; 2. School of Medicine, Xi’an Jiaotong University, Xi’an 710061, China; 3. Department of General Surgery, the First Affiliated Hospital, ?School of Medicine, Xi’an Jiaotong University, Xi’an 710061, China
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Abstract  

Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis. In the present paper, we report on a patient with advanced right colon cancer, including liver, gallbladder, and duodenal invasion behind the scene of liver abscess. En bloc resection was performed on the patient, with right-hemicolectomy, cholecystectomy, partial duodental resection, and hepatectomy. Postoperative management was administered, including nutritional support in the early postoperative period, effective anti-infection treatment, and adjuvant chemotherapy (FOLFOX4). The patient survived for 16 months after the operation. Common clinical manifestations of colorectal cancer were digestive symptoms and changes in defecation. However, the clinical manifestation of locally advanced colon cancer was extremely complicated. Extended or multivisceral resection may offer patients a chance to survive an acute crisis and allow for treatment with adjuvant therapy.

Keywords liver abscess      locally advanced colon cancer      multiorganic invasion     
Corresponding Authors: Liu Chang,Email:eyrechang@126.com   
Issue Date: 05 December 2011
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0157-3     OR     http://academic.hep.com.cn/fmd/EN/Y2011/V5/I4/434
Fig.1  Transverse CT scan demonstrated a large cavity within the segment V of the hepatic parenchyma (7.4 cm × 8.9 cm × 9.0 cm in size, thick arrow) with air (thin arrow). CT morphological features facilitated the diagnosis of the abscess. No other lesions were found in the liver.
Fig.2  Colography demonstrated a fistula connecting the hepatic flexure of the colon with the liver abscess cavity (arrow).
Fig.3  Abscess boundaries after drainage included the liver (L), gallbladder (G), duodenum (D), colon (C), and the cavity of abscess (A).
Fig.4  Results of the histological examination. (A) Tissue of the duodenal resection showed a nest of adenocarcinoma (, hematoxylin and eosin stain × 40). (B) The magnified image depicts pale watery cytoplasm and clear nuclei in cells, both of which are consistent with adenocarcinoma (, hematoxylin and eosin stain × 400).
Fig.5  The operative diagram. (A) Anatomical relationship between the colon tumor and adjacent organs. (B) Complete resection including right-hemicolectomy (I), partial duodenal resection (II), partial hepatectomy (III), gastrojejunostomy (IV), mucous fistula (V), and ileostomy (VI). Three drainage tubes, including abscess cavity drainage tube (1), T-tube (2), and duodenal decompression drainage tube (3), were set.
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