Abstract
The patient was a 51-year-old man. Abdominal CT revealed thickness of the rectal wall and a 10-cm multinodular and hypodense liver tumor. We diagnosed rectal cancer and synchronous solitary liver metastasis with abscess formation. Based on percutanous drainage of the liver abscess, a fistula between the liver abscess and the duodenum was confirmed. Low anterior resection for rectal cancer was performed and he underwent systemic chemotherapy with capecitabine and oxaliplatin subsequently. As no metastatic lesion except solitary liver metastasis was detected after eight courses of systemic chemotherapy, lateral segmentectomy and resection of the antrum of the stomach and the duodenal bulb were performed. The pathological findings revealed that the liver tumor consisted of well-differentiated adenocarcinoma and was compatible with metastasis of rectal cancer. Although liver metastasis had invaded the serosa in the greater part of the stomach and duodenum, the invasion extended to just below the mucosa of the duodenum only at the site of the fistula. This suggested that the fistula was due to the effects of inflammation from the synchronous liver metastasis with abscess formation. We report a very rare case of liver metastasis with abscess formation and fistulization into the duodenum.
