Absceso hepático secundario a fístula de tumor localizado en ángulo hepático de colon. Reporte de caso

Abstract

Colorectal cancer is one of the leading causes of morbidity and mortality worldwide and represents the third most commonly diagnosed cancer worldwide, with an incidence rate of 18.4 new cases and a mortality rate of 8.1 deaths per 100,000 people per year. Although it’s usual presentation includes gastrointestinal bleeding or intestinal obstruction, in rare cases it can manifest through atypical infectious complications such as liver abscess. The overall objective of this research was to analyse the clinical presentation, diagnosis, treatment and evolution of a case of liver abscess secondary to a fistula from a tumour located in the hepatic angle of the colon, highlighting its relevance for clinical practice. A descriptive-narrative methodology was used in this clinical case, complemented by a literature review. We present the case of an elderly adult patient who was admitted with abdominal pain, melena, anaemia, and systemic inflammatory response, in whom initial imaging studies suggested a pyogenic liver abscess. The clinical course, together with triphasic tomography and percutaneous drainage, revealed faecaloid content, which led to suspicion of a colohepatic fistula. Exploratory laparotomy confirmed the presence of a perforated tumour of the hepatic flexure of the colon with hepatic cavitation, and a right hemicolectomy and colostomy were performed. This case highlights the importance of considering occult colorectal neoplasms in patients with liver abscesses of unknown cause and underscores the need for a timely and multidisciplinary diagnostic approach to improve clinical outcomes.