Abstract
A 57-year-old male patient visited a doctor in his neighborhood complaining of generalized arthralgia and diarrhea. After he received treatment as an outpatient, the symptoms became less severe. He had a fever of 38-40°C and a blood test revealed that he developed a severe inflammatory response. 2 days later, he was referred to our hospital. Based on the results of an abdominal CT scan and ultrasonography, he was diagnosed with liver abscess and immediately hospitalized. He received meropenem but his fever stayed high. Percutaneous transhepatic abscess drainage (PTAD) was then performed. While yellow purulent fluid was aspirated, it was negative both for microbiological tests and cytology. Since the day following PTAD, the fever went down to 38°C or lower while the symptoms improved and the inflammatory response also abated. In parallel, therefore, we investigated the cause of the liver abscess. A barium enema examination revealed a 4-cm ulcerated lesion on the anterior wall of the rectum below the peritoneal reflection (Rb), which was diagnosed as rectal cancer. Abdominoperineal resection (Miles procedure) was performed and the histopathology of the surgical specimens revealed moderately differentiated adenocarcinoma. The depth of invasion was ‘A'. It was stage II rectal cancer without lymph node metastasis, peritoneal dissemination or distant metastasis. In the effort to identify the cause of hepatic abscess, gastrointestinal examinations should be performed at the earliest possible stage.
