title: Hepatogastric fistula: a rare complication of pyogenic liver abscess.
abstract: Hepatogastric fistula is very rare. We report a case of hepatogastric fistula as a complication of pyogenic liver abscess. A 40-year-old man presented with upper abdominal pain and high-grade fever of 2 weeks. Evaluation revealed multiple liver abscesses. On an empirical diagnosis of pyogenic liver abscess, he was treated with antibiotics. During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. As expectant management failed to resolve the abscess, endoscopic retrograde papillotomy and stenting of common bile duct was performed. After endoscopic stenting, symptoms subsided. Imaging repeated after 2 weeks of endoscopic stenting showed resolving abscess. He was discharged and is doing well on regular follow-ups. We conclude that hepatogastric fistula can be managed by endoscopic stenting as bile flow through the stent hastens resolution and healing of the fistula.
authors.affiliation: Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
authors.forename: Venkata Srinivas
authors.initials: VS
authors.lastname: Gandham
authors.affiliation: Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Pottakkat
authors.affiliation: Department of Medical Gastroenterology, SUT Hospital, Thiruvananthapuram, Kerala, India.
authors.forename: Lakshmi C
authors.initials: LC
authors.lastname: Panicker
authors.affiliation: Department of Surgical Gastroenterology, SUT Hospital, Thiruvananthapuram, Kerala, India.
authors.forename: Ranjit Vijaya
authors.initials: RV
authors.lastname: Hari
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001658:Biliary Fistula / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005334:Fever / Q000209:etiology; D005747:Gastric Fistula / Q000150:complications / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents