S0173 Liver Abscess as a Sentinel Finding in Diverticular Disease

Abstract

INTRODUCTION: Mucosal lesions in the colon allow for the transposition of bacteria from the bowel lumen into the portal venous blood stream. The hematogenous spread of bacteria to the liver has been hypothesized to contribute to the development of pyogenic liver abscesses. However, there is a paucity of literature outside of case reports and several small studies to suggest a link between colon pathology and liver abscesses. This study aims to explore the relationship between diverticular disease and liver abscesses in residents of Philadelphia hospitalized between 2002 and 2018. METHODS: A total of 951,711 unique patient hospitalizations in Philadelphia from 2002-2018 were queried for diagnoses of liver abscess and diverticular disease using inpatient data collected by the Pennsylvania Health Care Cost Containment Council. Odds ratio analysis was used to determine association between liver abscess and diverticular disease. RESULTS: A positive association between liver abscesses (n = 409) and diverticular disease (n = 49,798) was discovered (OR = 6.18; 95% CI = 4.96–7.73) with 104 patients carrying both diagnoses. Although only 0.2% of patients with diverticular disease had diagnosed liver abscesses, an overwhelming 25.4% of patients with liver abscesses had diverticular disease. CONCLUSION: Although the most common origin of liver abscess is pancreaticobiliary, small studies have demonstrated association of colon pathology such as cancer, ulcers, and polyps with development of pyogenic liver abscesses. In this study, we have demonstrated a strong association between liver abscesses and diverticular disease which suggests that a large portion of patients with liver abscesses also have underlying diverticulosis. For this reason, discovery of cryptogenic liver abscesses in a patient with no pancreaticobiliary explanation should prompt thorough survey of the colon with colonoscopy or radiographic imaging to rule out colonic causes such as cancer or diverticular disease.