Correspondence: H. Cerwenka, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. Tel: � 43 316 38512755. Fax: � 43 316 38514666. E-mail: herwig.cerwenka@medunigraz.at

(Received 21 September 2012 ; accepted 22 September 2012 )

Scandinavian Journal of Infectious Diseases, 2013; 45: 336

ISSN 0036-5548 print/ISSN 1651-1980 online © 2013 Informa HealthcareDOI: 10.3109/00365548.2012.733957

LETTER TO THE EDITOR

Colorectal neoplasia and pyogenic liver abscess

HERWIG CERWENKA

From the Department of Surgery, Medical University of Graz, Austria

To the Editor,

We read with interest the article entitled “ Pyogenic liver abscess and colorectal neoplasia ” by Chen et al. [1] and would like to thank the authors for highlight-ing this topic.

Although colorectal lesions in patients with pyo-genic liver abscesses can also be a coincidence and a recent study has shown an elevated standard inci-dence ratio of all cancers in these patients [2], a break in the mucosal barrier [3,4] may provide the route for portal vein bacteraemia and bacterial seeding. We recently operated on a 46-y-old patient with a pre-operative suspicion of appendicitis and a solitary hepatic abscess (liver segment 6; 2.5 cm in diameter; diagnosed by computed tomography scan). Histology revealed an adenocarcinoma of the appendix. A right hemicolectomy was done and the liver abscess was evacuated and drained. Microbiology showed a mixed bacterial fl ora with Escherichia coli, Enterococcus faecium, and Parvi-monas micra.

In our region, biliary disorders are the most important underlying diseases in patients with pyo-genic liver abscess [5,6]; however, in ‘ cryptogenic ’ abscesses other associated conditions such as malig-nancies of the gastrointestinal tract or foreign bodies should always be considered [7 – 9].

Declaration of interest: The authors report no confl icts of interest. The authors alone are respon-sible for the content and writing of the paper.

References

Chen YY , Lee JC , Yen HH , Wu SS , Soon MS . Pyogenic liver [1] abscess and colorectal neoplasia: a case series . Scand J Infect Dis 2012 Aug 5 . [Epub ahead of print] Kao WY , Hwang CY , Chang YT , Su CW , Hou MC , Lin HC , [2] et al . Cancer risk in patients with pyogenic liver abscess: a nation-wide cohort study . Aliment Pharmacol Ther 2012 ; 36 : 467 – 76 . Kumar A , Artifon E , Siegel C , Halwan B . Gastrointestinal [3] stromal tumor in association with pyogenic liver abscess . Gastroenterol Hepatol 2008 ; 4 : 818 – 9 . Cerwenka H , Bacher H , Werkgartner G , El-Shabrawi A , [4] Kornprat P , Bernhardt GA , et al . Treatment of patients with pyogenic liver abscess . Chemotherapy 2005 ; 51 : 366 – 9 . Cerwenka H . Pyogenic liver abscess: differences in etiology [5] and treatment in Southeast Asia and Central Europe . World J Gastroenterol 2010 ; 16 : 2458 – 62 . Cerwenka H , Bacher H , Werkgartner G , El-Shabrawi A , [6] Kornprat P , Bernhardt GA , et al . Treatment of patients with pyogenic liver abscess . Chemotherapy 2005 ; 51 : 366 – 9 . Cerwenka H . Pyogenic liver abscess and silent pathologies of the [7] digestive tract . Gastroenterol Hepatol (N Y) 2008 ; 4 : 819 – 20 . Leggieri N , Marques-Vidal P , Cerwenka H , Denys A , Dorta [8] G , Moutardier V , et al . Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed algo-rithm . Medicine (Baltimore) 2010 ; 89 : 85 – 95 . Lai HC , Lin HC . Cryptogenic pyogenic liver abscess as a sign [9] of colorectal cancer: a population-based 5-year follow-up study . Liver Int 2010 ; 30 : 1387 – 93 .

Scan

d J

Infe

ct D

is D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y N

atio

nal S

ilico

sis

Lib

rary

on

11/0

6/14

For

pers

onal

use

onl

y.