Emuejevuoke Umukoro, DO1, Faizi Hai, MD2 1Scripps Mercy Hospital, San Ysidro, CA; 2Scripps Green Hospital, La Jolla, CA
Introduction: Gastrointestinal tract fistula can occur due to abdominal trauma, surgery, infection, inflammatory processes or malignancy. Hepatoduodenal fistulas are a variety of enteric fistulas that have been associated with liver abscesses and hepatocellular carcinoma treatment. However, they can also result from necrosis of metastatic liver lesions.
Case Description/Methods: A 58-year-old female was admitted due to significant rigors, chills, nausea, vomiting and intermittent fevers. She was diagnosed with sigmoid colon adenocarcinoma with liver metastases 2 years prior and had previously undergone laparoscopic colectomy, chemotherapy and stereotactic body radiation therapy (SBRT). CT abdomen/pelvis with IV contrast showed a hypodense metastatic mass within the right lobe of the liver measuring 5.6 x 5.2 cm with increasing gas, suspicious for superinfection or fistulization with adjacent duodenum. CT abdomen with oral contrast revealed extension of oral contrast into the hepatic mass, compatible with duodenal fistula to the right hepatic mass. Esophagogastroduodenoscopy (EGD) revealed a large necrotic opening consistent with a fistula, which was not closed to prevent abscess formation. She was discharged on antibiotics. Subsequently, she returned with similar symptoms and was re-treated with antibiotics. Her bilirubin level continued to rise and functional status worsened. So, the patient was transitioned to hospice care and passed away one month later.
Discussion: Hepatoduodenal fistulas are an uncommon complication of liver metastases from colon cancer. They can develop due to tumor necrosis, especially after chemotherapy and radiation therapy, and become a possible nidus for the formation of an abscess. Such fistulas should be monitored to prevent further complications.
Figure: Figure 1. CT abdomen/pelvis with IV contrast showing areas of metastases in the right hepatic lobe with gas in axial (A) and coronal (B) views.
Disclosures:
Emuejevuoke Umukoro indicated no relevant financial relationships.
Faizi Hai indicated no relevant financial relationships.
Emuejevuoke Umukoro, DO1, Faizi Hai, MD2. P1671 - Hepatoduodenal Fistula Formation in a Necrotic Liver Metastasis From Sigmoid Colon Cancer, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
