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Malignant hepatogastric fistula with associated secondary liver abscess: a rare complication of an occult gastric adenocarcinoma
  1. Alexander Mimery1,
  2. Nicolas Ramly2,
  3. Amitabha Das2 and
  4. Kheman Rajkomar3
  1. 1Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
  2. 2Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
  3. 3Upper Gastrointestinal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Alexander Mimery; a.mimery{at}gmail.com

Abstract

A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.

  • ulcer
  • gastric cancer
  • gastrointestinal surgery

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Footnotes

  • Contributors AM: Primary author, compiled report. NR: Surgical resident involved in patient care, literature review and compiling figures. AD: Consultant surgeon involved in patient care. KR: Consultant surgeon involved in patient care, primary supervisor, literature review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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