LETTER
TO THE
EDITOR
Liver Abscess in Patients with Underlying Inflammatory Bowel Diseases To the Editor: We would like to thank the author’s interest in our article.1 Liver abscess is a rare hepatobiliary complication in inflammatory bowel diseases (IBD). Most cases described to date were found in patients with Crohn’s disease (CD). The reported incidence of this disease entity in patients with CD is 114 to 297 per 100,000, a rate that is about 10 to 15 times higher than that found in the general population.2 In contrast, liver abscess developed in patients with underlying ulcerative colitis (UC) are less frequently encountered in the routine clinical practice. To the best of our knowledge, only 11 cases have been published in the literature since the first case of liver abscess in a patient with UC was reported by Lansbury and Bargen in 1993.3–11 Liver abscess with IBD has been considered to be mainly of microbial origin. It is more likely to be monomicrobial than those developed in the general population, with Streptococcus being the most common pathogen identified, followed by Escherichia coli.3,4,12 However, not all liver abscesses have identifiable pathogens (i.e., aseptic liver abscess). Aseptic liver abscess may represent a special subgroup, characterized by deep, sterile, and round lesions consisting of neutrophil infiltration that do not respond to antibiotics but improve dramatically with corticosteroids.13 Because aseptic liver abscess is believed to share similar pathogenic mechanisms with pyoderma gangrenosum and Sweet’s syndrome, it is suggested that it in fact represents an extraintestinal manifestation of IBD and part of the spectrum of neutrophilic disease.14,15 Nevertheless, negative bacterial culture and serology do not The authors have no conflicts of interest to disclose. Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/01.MIB.0000435852.39502.5a Published online 7 November 2013.
necessarily mean that abscess is aseptic. Differential diagnoses, such as those from slowly growing organisms and those with the absence of causative agents because of previous antibiotic therapies, need to be considered.16 Clinical manifestations of liver abscess may include fever, chills, anorexia, weight loss, abdominal pain, right upper quadrant tenderness, and right pleural effusion.3,10,17 Since most of the symptoms are nonspecific, they can be mistaken as a disease exacerbation of underlying IBD. The abscess almost invariably involves the right lobe of the liver.2,10,18 The predilection for the right lobe may be explained anatomically, as the lobe receives blood from both superior mesenteric and portal veins, whereas, the left lobe receives the drainage from the inferior mesenteric and splenic veins. In line with the general population, liver abscess seems to have a male predominance. However, patients with IBD tend to develop this disease entity at a younger age and more frequently to have multiple lesions.2,3,18,19 Most liver abscesses developed in patients with a long-standing IBD, but liver abscesses preceding the diagnosis of IBD are increasingly reported.4,16,20–22 Although the exact etiology for liver abscess in patients with IBD remains obscure, it is speculated that there might be propagation through the portal venous system of bacteremia with intestinal organisms because of the ulceration and loss of integrity of the normal mucosal barrier.2,4,10,12,20,23–26 Studies suggesting an increased incidence of portal bacteremia in patients with IBD further support this hypothesis.6,27 Other purported risk factors include abdominal surgery, inflammatory and perforating diseases of the gut, fistulae, and intra-abdominal abscess and malnutrition.2–4,16,18 Patients with a longterm use of IBD-related medications may also be prone to developing liver abscess. For instance, the use of metronidazole was reported to predispose to abscess formation by altering bowel flora,28 whereas, corticosteroids may predispose patients to this condition by their immunosuppressive effect.18,29 Liver abscess formed in a patient with CD who was on infliximab was reported.30
Inflamm Bowel Dis Volume 19, Number 13, December 2013
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease of unknown etiology characterized by ongoing inflammation, destruction, and fibrosis of intrahepatic and extrahepatic bile ducts. The association of PSC and IBD was initially described in 1965, and it is now recognized that PSC represents the most common hepatopancreatobiliary manifestation of IBD.31 The prevalence of IBD in patients with PSC is 60% to 80%, with UC being the predominant form.32 In theory, patients with PSC are associated with an increased risk for the development of liver abscess, particularly in the context of underlying IBD, because microbes may disseminate through the biliary tract secondary to ascending cholangitis.3,33 Surprisingly, there are only scant data to document the coexistence of PSC and liver abscess. In 1971, Wagner34 reported on a case with non-IBD PSC whose necropsy showed numerous liver abscesses scattered all over the liver, and the fatal outcome of this patient was attributed to the use of azathioprine and corticosteroids. A cohort study from Singapore35 demonstrated that, of 10 cases with PSC, a non-IBD patient was found to be complicated by liver abscess. In 2004, Margalit et al3 described 2 cases with IBD (one with UC and the other with CD) developed multiple liver abscesses in addition to existing PSC. The latest report of such a case was published in 2008, in which a patient with CD complicated by PSC developed multiple liver abscesses from Candida albicans.36 Restorative proctocolectomy with an ileal pouch–anal anastomosis (IPAA) has been widely accepted as the surgical procedure of choice for patients with UC and a carefully selected patient population with isolated Crohn’s colitis. This bowelanatomy–altering procedure significantly improves patients’ health-related quality of life by preserving the natural route of defecation. Whether IPAA patients are predisposed to liver abscesses is unclear. A careful search of the literature yields no published data regarding this specific topic. However, we would expect a higher incidence rate of liver abscess in patients with ileal pouches than in the general population, especially in those with chronic www.ibdjournal.org |
Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
E87
Inflamm Bowel Dis Volume 19, Number 13, December 2013
Letter to the Editor
pouchitis and CD of the pouch, since the clinical features of these 2 disease entities mimic those of UC and CD as shown by our previous studies.1,37,38 In our current large series of IPAA patients, we did not encounter liver abscess in those with or without concurrent PSC. The possible explanation could be that immunosuppressive agents were hardly used in IPAA patients, unless they had a diagnosis of CD of the pouch or chronic pouchitis. Our study, however, showed that patients with PSC had a protective effect on the development of CD of the pouch. In conclusion, liver abscess may be more often seen in patients with IBD than in the general population, particularly for those with CD. The etiology of liver abscess in IBD is enigmatic, but the increased mucosal permeability seems to play a role. Only few cases have been published to date pertaining to the coexistence of liver abscess and PSC, as opposed to the theoretical higher incidence of liver abscess in patients with PSC. There are no data in the literature on the incidence or prevalence of liver abscesses in patients with ileal pouches.
Xian-rui Wu, MD, PhD* Bo Shen, MD† *Departments of Colorectal Surgery, and † Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, Ohio
REFERENCES 1. Wu XR, Mukewar S, Kiran RP, et al. The presence of primary sclerosing cholangitis is protective for ileal pouch from Crohn’s disease. Inflamm Bowel Dis. 2013;19:1483–1489. 2. Mir-Madjlessi SH, McHenry MC, Farmer RG. Liver abscess in Crohn’s disease. Report of four cases and review of the literature. Gastroenterology. 1986;91: 987–993. 3. Margalit M, Elinav H, Ilan Y, et al. Liver abscess in inflammatory bowel disease: report of two cases and
E88
4.
5.
6.
7. 8.
9. 10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
review of the literature. J Gastroenterol Hepatol. 2004;19:1338–1342. Song J, Swekla M, Colorado P, et al. Liver abscess and diarrhea as initial manifestations of ulcerative colitis: case report and review of the literature. Dig Dis Sci. 2003;48:417–421. Ji JS, Kim HK, Kim SS, et al. Combined hepatic and splenic abscesses in a patient with ulcerative colitis. J Korean Med Sci. 2007;22:750–753. Inoue T, Hirata I, Egashira Y, et al. Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: a case report. World J Gastroenterol. 2005;11:5241–5244. Dabrowski M, Koc J, Kus J. [Liver abscess in the course of ulcerative colitis]. Wiad Lek. 1997;50:117–119. Treusch JV. Multiple liver abscesses complicating non-specific chronic ulcerative colitis: report of a case. Gastroenterology. 1952;20:166–173. Davidson JS. Solitary pyogenic liver abscess. Br Med J. 1964;2:613–615. Albuquerque A, Magro F, Rodrigues S, et al. Liver abscess of the caudate lobe due to Staphylococcus aureus in an ulcerative colitis patient: first case report. J Crohns Colitis. 2011;5:360–363. Wells CD, Balan V, Smilack JD. Pyogenic liver abscess after colonoscopy in a patient with ulcerative colitis. Clin Gastroenterol Hepatol. 2005;3:24. Bernabeu JL, Leo E, Trigo C, et al. Crohn’s disease and liver abscess due to Pediococcus sp. Inflamm Bowel Dis. 2011;17:2207–2208. Andre MF, Piette JC, Kemeny JL, et al. Aseptic abscesses: a study of 30 patients with or without inflammatory bowel disease and review of the literature. Medicine (Baltimore). 2007;86:145–161. Zakout R, Fonseca M, Santos JM, et al. Multiple aseptic liver abscesses as the initial manifestation of Crohn’s disease: report of a case. Dis Colon Rectum. 2009;52:343–345. Andre M, Aumaitre O, Papo T, et al. Disseminated aseptic abscesses associated with Crohn’s disease: a new entity? Dig Dis Sci. 1998;43:420–428. Hazzan D, Fishman E, Heller E, et al. Liver abscess in Crohn’s disease: a report of three cases. Mt Sinai J Med. 2004;71:351–354. Valero V, Senior J, Watanakunakorn C. Liver abscess complicating Crohn’s disease presenting as thoracic empyema. Case report and review of the literature. Am J Med. 1985;79:659–662. Vakil N, Hayne G, Sharma A, et al. Liver abscess in Crohn’s disease. Am J Gastroenterol. 1994;89: 1090–1095. Teague M, Baddour LM, Wruble LD. Liver abscess: a harbinger of Crohn’s disease. Am J Gastroenterol. 1988;83:1412–1414. Famularo G, Tesi A, Luzi C, et al. A relapsing liver abscess in a patient with unrecognised Crohn’s disease. Dig Liver Dis. 2003;35:516. Narayanan S, Madda JP, Johny M, et al. Crohn’s disease presenting as pyogenic liver abscess with
22.
23.
24.
25.
26.
27. 28.
29.
30.
31.
32.
33.
34. 35.
36.
37.
38.
review of previous case reports. Am J Gastroenterol. 1998;93:2607–2609. Navot-Mintzer D, Koren A, Shahbari A, et al. Liver abscesses as the presenting manifestation of Crohn’s disease in an adolescent. Inflamm Bowel Dis. 2006; 12:666–667. Goletti O, Angrisano C, Lippolis PV, et al. Percutaneous management of multiple bilateral liver abscesses complicating Crohn disease. Surg Laparosc Endosc Percutan Tech. 2001;11:131–133. Aguas M, Bastida G, Nos P, et al. Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn’s disease at onset. BMC Gastroenterol. 2007;7:22. Darnell A, Brullet E, Campo R, et al. Liver abscesses as initial presentation of Crohn’s disease. Am J Gastroenterol. 1995;90:1363–1364. Molina Infante J, Banares Canizares R, Gomez Camarero J, et al. [Liver abscess and Crohn’s disease. Report of 3 cases]. Gastroenterol Hepatol. 2004;27:317–319. Brooke BN, Slaney G. Portal bacteraemia in ulcerative colitis. Lancet. 1958;1:1206–1207. Hatoff DE. Perineal Crohn’s disease complicated by pyogenic liver abscess during metronidazole therapy. Gastroenterology. 1983;85:194–195. Manjunatha S, McIntyre PB, Lynn A. Multiple liver abscesses in Crohn’s disease. Br J Hosp Med. 1992; 47:375–376. Patel TR, Patel KN, Boyarsky AH. Staphylococcal liver abscess and acute cholecystitis in a patient with Crohn’s disease receiving infliximab. J Gastrointest Surg. 2006;10:105–110. Navaneethan U, Shen B. Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease. Inflamm Bowel Dis. 2010;16:1598–1619. Broome U, Bergquist A. Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer. Semin Liver Dis. 2006;26:31–41. Zarnow H, Grant TH, Spellberg M, et al. Unusual complications of regional enteritis. Duodenobiliary fistula and hepatic abscess. JAMA. 1976;235:1880–1881. Wagner A. Azathioprine treatment in primary sclerosing cholangitis. Lancet. 1971;2:663–664. Ang TL, Fock KM, Ng TM, et al. Clinical profile of primary sclerosing cholangitis in Singapore. J Gastroenterol Hepatol. 2002;17:908–913. Melero JL, Bastida G, Yago M, et al. [Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn’s disease]. Gastroenterol Hepatol. 2008;31:576–579. Shen B, Remzi FH, Brzezinski A, et al. Risk factors for pouch failure in patients with different phenotypes of Crohn’s disease of the pouch. Inflamm Bowel Dis. 2008;14:942–948. Shen B. Acute and chronic pouchitis—pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9:323–333.
| www.ibdjournal.org
Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
TO THE
EDITOR
Liver Abscess in Patients with Underlying Inflammatory Bowel Diseases To the Editor: We would like to thank the author’s interest in our article.1 Liver abscess is a rare hepatobiliary complication in inflammatory bowel diseases (IBD). Most cases described to date were found in patients with Crohn’s disease (CD). The reported incidence of this disease entity in patients with CD is 114 to 297 per 100,000, a rate that is about 10 to 15 times higher than that found in the general population.2 In contrast, liver abscess developed in patients with underlying ulcerative colitis (UC) are less frequently encountered in the routine clinical practice. To the best of our knowledge, only 11 cases have been published in the literature since the first case of liver abscess in a patient with UC was reported by Lansbury and Bargen in 1993.3–11 Liver abscess with IBD has been considered to be mainly of microbial origin. It is more likely to be monomicrobial than those developed in the general population, with Streptococcus being the most common pathogen identified, followed by Escherichia coli.3,4,12 However, not all liver abscesses have identifiable pathogens (i.e., aseptic liver abscess). Aseptic liver abscess may represent a special subgroup, characterized by deep, sterile, and round lesions consisting of neutrophil infiltration that do not respond to antibiotics but improve dramatically with corticosteroids.13 Because aseptic liver abscess is believed to share similar pathogenic mechanisms with pyoderma gangrenosum and Sweet’s syndrome, it is suggested that it in fact represents an extraintestinal manifestation of IBD and part of the spectrum of neutrophilic disease.14,15 Nevertheless, negative bacterial culture and serology do not The authors have no conflicts of interest to disclose. Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/01.MIB.0000435852.39502.5a Published online 7 November 2013.
necessarily mean that abscess is aseptic. Differential diagnoses, such as those from slowly growing organisms and those with the absence of causative agents because of previous antibiotic therapies, need to be considered.16 Clinical manifestations of liver abscess may include fever, chills, anorexia, weight loss, abdominal pain, right upper quadrant tenderness, and right pleural effusion.3,10,17 Since most of the symptoms are nonspecific, they can be mistaken as a disease exacerbation of underlying IBD. The abscess almost invariably involves the right lobe of the liver.2,10,18 The predilection for the right lobe may be explained anatomically, as the lobe receives blood from both superior mesenteric and portal veins, whereas, the left lobe receives the drainage from the inferior mesenteric and splenic veins. In line with the general population, liver abscess seems to have a male predominance. However, patients with IBD tend to develop this disease entity at a younger age and more frequently to have multiple lesions.2,3,18,19 Most liver abscesses developed in patients with a long-standing IBD, but liver abscesses preceding the diagnosis of IBD are increasingly reported.4,16,20–22 Although the exact etiology for liver abscess in patients with IBD remains obscure, it is speculated that there might be propagation through the portal venous system of bacteremia with intestinal organisms because of the ulceration and loss of integrity of the normal mucosal barrier.2,4,10,12,20,23–26 Studies suggesting an increased incidence of portal bacteremia in patients with IBD further support this hypothesis.6,27 Other purported risk factors include abdominal surgery, inflammatory and perforating diseases of the gut, fistulae, and intra-abdominal abscess and malnutrition.2–4,16,18 Patients with a longterm use of IBD-related medications may also be prone to developing liver abscess. For instance, the use of metronidazole was reported to predispose to abscess formation by altering bowel flora,28 whereas, corticosteroids may predispose patients to this condition by their immunosuppressive effect.18,29 Liver abscess formed in a patient with CD who was on infliximab was reported.30
Inflamm Bowel Dis Volume 19, Number 13, December 2013
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease of unknown etiology characterized by ongoing inflammation, destruction, and fibrosis of intrahepatic and extrahepatic bile ducts. The association of PSC and IBD was initially described in 1965, and it is now recognized that PSC represents the most common hepatopancreatobiliary manifestation of IBD.31 The prevalence of IBD in patients with PSC is 60% to 80%, with UC being the predominant form.32 In theory, patients with PSC are associated with an increased risk for the development of liver abscess, particularly in the context of underlying IBD, because microbes may disseminate through the biliary tract secondary to ascending cholangitis.3,33 Surprisingly, there are only scant data to document the coexistence of PSC and liver abscess. In 1971, Wagner34 reported on a case with non-IBD PSC whose necropsy showed numerous liver abscesses scattered all over the liver, and the fatal outcome of this patient was attributed to the use of azathioprine and corticosteroids. A cohort study from Singapore35 demonstrated that, of 10 cases with PSC, a non-IBD patient was found to be complicated by liver abscess. In 2004, Margalit et al3 described 2 cases with IBD (one with UC and the other with CD) developed multiple liver abscesses in addition to existing PSC. The latest report of such a case was published in 2008, in which a patient with CD complicated by PSC developed multiple liver abscesses from Candida albicans.36 Restorative proctocolectomy with an ileal pouch–anal anastomosis (IPAA) has been widely accepted as the surgical procedure of choice for patients with UC and a carefully selected patient population with isolated Crohn’s colitis. This bowelanatomy–altering procedure significantly improves patients’ health-related quality of life by preserving the natural route of defecation. Whether IPAA patients are predisposed to liver abscesses is unclear. A careful search of the literature yields no published data regarding this specific topic. However, we would expect a higher incidence rate of liver abscess in patients with ileal pouches than in the general population, especially in those with chronic www.ibdjournal.org |
Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
E87
Inflamm Bowel Dis Volume 19, Number 13, December 2013
Letter to the Editor
pouchitis and CD of the pouch, since the clinical features of these 2 disease entities mimic those of UC and CD as shown by our previous studies.1,37,38 In our current large series of IPAA patients, we did not encounter liver abscess in those with or without concurrent PSC. The possible explanation could be that immunosuppressive agents were hardly used in IPAA patients, unless they had a diagnosis of CD of the pouch or chronic pouchitis. Our study, however, showed that patients with PSC had a protective effect on the development of CD of the pouch. In conclusion, liver abscess may be more often seen in patients with IBD than in the general population, particularly for those with CD. The etiology of liver abscess in IBD is enigmatic, but the increased mucosal permeability seems to play a role. Only few cases have been published to date pertaining to the coexistence of liver abscess and PSC, as opposed to the theoretical higher incidence of liver abscess in patients with PSC. There are no data in the literature on the incidence or prevalence of liver abscesses in patients with ileal pouches.
Xian-rui Wu, MD, PhD* Bo Shen, MD† *Departments of Colorectal Surgery, and † Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, Ohio
REFERENCES 1. Wu XR, Mukewar S, Kiran RP, et al. The presence of primary sclerosing cholangitis is protective for ileal pouch from Crohn’s disease. Inflamm Bowel Dis. 2013;19:1483–1489. 2. Mir-Madjlessi SH, McHenry MC, Farmer RG. Liver abscess in Crohn’s disease. Report of four cases and review of the literature. Gastroenterology. 1986;91: 987–993. 3. Margalit M, Elinav H, Ilan Y, et al. Liver abscess in inflammatory bowel disease: report of two cases and
E88
4.
5.
6.
7. 8.
9. 10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
review of the literature. J Gastroenterol Hepatol. 2004;19:1338–1342. Song J, Swekla M, Colorado P, et al. Liver abscess and diarrhea as initial manifestations of ulcerative colitis: case report and review of the literature. Dig Dis Sci. 2003;48:417–421. Ji JS, Kim HK, Kim SS, et al. Combined hepatic and splenic abscesses in a patient with ulcerative colitis. J Korean Med Sci. 2007;22:750–753. Inoue T, Hirata I, Egashira Y, et al. Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: a case report. World J Gastroenterol. 2005;11:5241–5244. Dabrowski M, Koc J, Kus J. [Liver abscess in the course of ulcerative colitis]. Wiad Lek. 1997;50:117–119. Treusch JV. Multiple liver abscesses complicating non-specific chronic ulcerative colitis: report of a case. Gastroenterology. 1952;20:166–173. Davidson JS. Solitary pyogenic liver abscess. Br Med J. 1964;2:613–615. Albuquerque A, Magro F, Rodrigues S, et al. Liver abscess of the caudate lobe due to Staphylococcus aureus in an ulcerative colitis patient: first case report. J Crohns Colitis. 2011;5:360–363. Wells CD, Balan V, Smilack JD. Pyogenic liver abscess after colonoscopy in a patient with ulcerative colitis. Clin Gastroenterol Hepatol. 2005;3:24. Bernabeu JL, Leo E, Trigo C, et al. Crohn’s disease and liver abscess due to Pediococcus sp. Inflamm Bowel Dis. 2011;17:2207–2208. Andre MF, Piette JC, Kemeny JL, et al. Aseptic abscesses: a study of 30 patients with or without inflammatory bowel disease and review of the literature. Medicine (Baltimore). 2007;86:145–161. Zakout R, Fonseca M, Santos JM, et al. Multiple aseptic liver abscesses as the initial manifestation of Crohn’s disease: report of a case. Dis Colon Rectum. 2009;52:343–345. Andre M, Aumaitre O, Papo T, et al. Disseminated aseptic abscesses associated with Crohn’s disease: a new entity? Dig Dis Sci. 1998;43:420–428. Hazzan D, Fishman E, Heller E, et al. Liver abscess in Crohn’s disease: a report of three cases. Mt Sinai J Med. 2004;71:351–354. Valero V, Senior J, Watanakunakorn C. Liver abscess complicating Crohn’s disease presenting as thoracic empyema. Case report and review of the literature. Am J Med. 1985;79:659–662. Vakil N, Hayne G, Sharma A, et al. Liver abscess in Crohn’s disease. Am J Gastroenterol. 1994;89: 1090–1095. Teague M, Baddour LM, Wruble LD. Liver abscess: a harbinger of Crohn’s disease. Am J Gastroenterol. 1988;83:1412–1414. Famularo G, Tesi A, Luzi C, et al. A relapsing liver abscess in a patient with unrecognised Crohn’s disease. Dig Liver Dis. 2003;35:516. Narayanan S, Madda JP, Johny M, et al. Crohn’s disease presenting as pyogenic liver abscess with
22.
23.
24.
25.
26.
27. 28.
29.
30.
31.
32.
33.
34. 35.
36.
37.
38.
review of previous case reports. Am J Gastroenterol. 1998;93:2607–2609. Navot-Mintzer D, Koren A, Shahbari A, et al. Liver abscesses as the presenting manifestation of Crohn’s disease in an adolescent. Inflamm Bowel Dis. 2006; 12:666–667. Goletti O, Angrisano C, Lippolis PV, et al. Percutaneous management of multiple bilateral liver abscesses complicating Crohn disease. Surg Laparosc Endosc Percutan Tech. 2001;11:131–133. Aguas M, Bastida G, Nos P, et al. Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn’s disease at onset. BMC Gastroenterol. 2007;7:22. Darnell A, Brullet E, Campo R, et al. Liver abscesses as initial presentation of Crohn’s disease. Am J Gastroenterol. 1995;90:1363–1364. Molina Infante J, Banares Canizares R, Gomez Camarero J, et al. [Liver abscess and Crohn’s disease. Report of 3 cases]. Gastroenterol Hepatol. 2004;27:317–319. Brooke BN, Slaney G. Portal bacteraemia in ulcerative colitis. Lancet. 1958;1:1206–1207. Hatoff DE. Perineal Crohn’s disease complicated by pyogenic liver abscess during metronidazole therapy. Gastroenterology. 1983;85:194–195. Manjunatha S, McIntyre PB, Lynn A. Multiple liver abscesses in Crohn’s disease. Br J Hosp Med. 1992; 47:375–376. Patel TR, Patel KN, Boyarsky AH. Staphylococcal liver abscess and acute cholecystitis in a patient with Crohn’s disease receiving infliximab. J Gastrointest Surg. 2006;10:105–110. Navaneethan U, Shen B. Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease. Inflamm Bowel Dis. 2010;16:1598–1619. Broome U, Bergquist A. Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer. Semin Liver Dis. 2006;26:31–41. Zarnow H, Grant TH, Spellberg M, et al. Unusual complications of regional enteritis. Duodenobiliary fistula and hepatic abscess. JAMA. 1976;235:1880–1881. Wagner A. Azathioprine treatment in primary sclerosing cholangitis. Lancet. 1971;2:663–664. Ang TL, Fock KM, Ng TM, et al. Clinical profile of primary sclerosing cholangitis in Singapore. J Gastroenterol Hepatol. 2002;17:908–913. Melero JL, Bastida G, Yago M, et al. [Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn’s disease]. Gastroenterol Hepatol. 2008;31:576–579. Shen B, Remzi FH, Brzezinski A, et al. Risk factors for pouch failure in patients with different phenotypes of Crohn’s disease of the pouch. Inflamm Bowel Dis. 2008;14:942–948. Shen B. Acute and chronic pouchitis—pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9:323–333.
| www.ibdjournal.org
Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
