2107 A Case of Crohn’s Disease Complicated With Liver Abscess, Enterohepatic and Enterocutaneous Fistulas

Abstract

INTRODUCTION: Crohn’s disease (CD) is a chronic inflammatory disease which can affect any part of the gastrointestinal tract. Liver abscesses and fistulas between a solid organ and intestine are rare. Here we present a unique case report of a CD patient who developed liver abscesses complicated by enterohepatic and enterocutaneous fistula. CASE DESCRIPTION/METHODS: 48-year-old male with a longstanding history of CD presented with abdominal pain. A CT of the abdomen revealed multifocal hepatic abscesses (Figure 1). The abscesses were initially percutaneously drained and antibiotics were administered. Five weeks following discharge he presented with complains of worsened abdominal pain. He had developed a foul smelling pus-draining wound at site of the drainage. A repeated CT abdomen revealed persistent hepatic abscess with small bubbles of free air adjacent to the inferior hepatic edge with a thin enhancing tract suggesting an early enterohepatic fistula (Figure 2) and an enterocutaneous fistula in the lateral abdominal wall between the bowel and the skin (Figure 3). He underwent a right hemicolectomy with drainage of the hepatic abscesses and repair of the enterocutaneous and enterohepatic fistula. The biopsies from the ileo-cecal region showed extensive ulceration with underling transmural inflammation of mucosa and extensive active inflammation of visceral serosa with reactive fibrosis, suggestive of severe CD. His postoperative recovery was uneventful. Routine colonoscopy evaluation of the ileo-colonic anastomosis two months later showed erythema and inflammation at the anastomosis site with granular inflammation throughout the colon (Figure 4). He is currently doing well on Infliximab and has not reported further complications. DISCUSSION: Liver abscess and solid organ to intestinal fistulas are rare complications of CD. The incidence of liver abscess is higher in patients with CD compared with the general population. The diagnosis of liver abscesses is frequently delayed as patients present similar to a CD exacerbation. Unlike the patient in this report, intestinal symptoms may be absent leaving little to no evidence to suggest the presence of a liver abscess on clinical presentation. Imaging including CT scans and ultrasound help to facilitate the diagnosis of this rare condition. In this case, we have shown that surgical intervention, antibiotics and immunotherapy can help with successful outcomes in cases of liver abscesses, enterohepatic and enterocutaneous fistulas.