Rupture of liver abscess following hepatogastric fistula caused by perforation of remnant gastric carcinoma: a case report

L.-M. Qian, J.-G. Ge, J.-M. Huang

Department of Gastrointestinal Surgery, the Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, Jiangsu, China. qqllmm2003@163.com

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• Gastroenterology

OBJECTIVE: We report the case of a 73-year-old man, with a history of proximal subtotal gastrectomy, who suffered acute abdominal symptoms and signs. Laparotomy showed rupture of liver abscess and hepatogastric fistula formation caused by perforation of remnant stomach.

CASE REPORT: Residual stomach resection, incision and drainage of liver abscess were performed, and the patient was smoothly discharged from hospital nineteen days after the emergency operation.

RESULTS: The final pathology confirmed the remnant gastric adenocarcinoma. This case is so far the first reported liver abscess caused by perforation of residual stomach malignant tumor.

CONCLUSIONS: Liver abscess and hepatogastric fistula are rare. This is the first report on a remnant gastric adenocarcinoma (RGC) invading the adjacent liver, with ruptured liver abscess resulting from gastric perforation. We speculated that there were inevitable factors for this case. Direct invasion to the liver capsule of gastric carcinoma was the bridging basic of the formation of a hepatogastric fistula. Pyloric obstruction caused by gastric carcinoma was the driver of liver abscess rupture since the increased proximal gastrointestinal pressure led to the inner pressure of liver abscess rising through the conduction of hepatogastric fistula. The recommended treatment protocol for this clinical entity comprises removal of the primary lesions and drainage of the liver abscess. This successful case provided us with a great deal of clinical information and treatment experience.

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