Korean J Gastroenterol.  2018 May;71(5):286-289. 10.4166/kjg.2018.71.5.286.

Liver Abscess Secondary to Perforation after Duodenal Endoscopic Resection

• Choi SH
• Kim SJ
• Kang DH
• Kim HW
• Choi CW
• Kim TU
• Lee JS
• Ko JH

• KMID: 2415487
• DOI: http://doi.org/10.4166/kjg.2018.71.5.286

Abstract

Duodenal perforation is a complication of endoscopic mucosal resection. Liver abscess secondary to iatrogenic perforation is extremely rare. A 43-year-old female visited the hospital to remove a sub-epithelial tumor on the duodenal bulb. After endoscopic mucosal resection with band ligation, duodenal perforation occurred. Endoscopic closure was performed successfully using a clipping device to manage duodenal perforation. After 4 weeks, the patient visited our outpatient clinic due to abdominal pain and fever. Abdominal computed tomography showed liver abscess that involved segment three. Liver abscess was resolved with a 10-week antibiotic treatment. To the best of our knowledge, no case of liver abscess secondary to duodenal perforation by endoscopic resection was reported to date in Korea. Here, we report a case of liver abscess caused by a duodenal perforation after endoscopic mucosal resection.

Keyword

Duodenum; Intestinal perforation; Endoscopic mucosal resection; Liver abscess

MeSH Terms

Abdominal Pain
Adult
Ambulatory Care Facilities
Duodenum
Female
Fever
Humans
Intestinal Perforation
Korea
Ligation
Liver Abscess*
Liver*

Figure

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  Fig. 1 (A) Yellowish sub-epithelial tumor with a size of about 0.5 cm with biopsy-induced erosion on the top of the lesion on the duodenal bulb. (B) Occurrence of perforation at the lateral resection margin (arrows) after endoscopic mucosal resection with band ligation. (C) Successful closure of perforation with endoscopic clips.

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  Fig. 2 (A) Abdominal X-ray after endoscopic resection showing bilateral sub-diaphragmatic free air. (B) Abdominal computed tomography scan showing the presence of pneumoperitoneum and clips in the duodenal bulb.

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  Fig. 3 (A) Liver abscess with a size of 7.5×7.0 cm is observed in the segment three on the abdominal computed tomography. (B) Disappearance of liver abscess on a follow-up study after antibiotic treatment.

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