[Pyogenic abscess in hepatic metastasis: unusual first manifestation of colorectal cancer. A case report]. / Metastasi ascessualizzata del fegato: insolita presentazione clinica del cancro colon-rettale. Caso clinico.

Pyogenic liver abscesses and colorectal cancer are rarely reported in association. Necrosis and infection of hepatic metastases from colorectal cancer are rare events which occur in the absence of systemic or local therapy. We report a case of a 72-year-old woman with a four day history of high fever, abdominal pain and a palpable mass in the right upper quadrant. Ultrasonography and CT scan showed a 13-cm solitary abscess in hepatic segment V-VI with multiple satellite metastases. For suspected imminent rupture into the peritoneal cavity a surgical drain was performed. Colorectal cancer was discovered during abdominal exploration and a colon resection was performed two weeks later. The search for the underlying cause of the pyogenic liver abscess should be an integral part of the correct management of liver abscesses. Association with a colorectal cancer is rare but should be taken into consideration.