Pyogenic Liver Abscess as a Fatal Complication of Colonoscopy: a case report

Background: Colonoscopy is a safe and routinely-performed diagnostic and screening procedure for different colorectal diseases. The diagnostic and screening colonoscopy for is different for colon diseases. In order for colonoscopy, colon cleansing is required to prepare a detailed view into the intestinal lumen. Aim: This is a case report study of a patient with multiple pyogenic liver abscesses following colonoscopy (unprep).  Methods: After studying hospital records of patient in GI section of Imam Reza Hospital and searching the websites, pubmed, Scopus, and Medline, we found no earlier reports of liver abscess after colonoscopy. Results: A diabetic patient suffered from fever, abdominal pain and drowsiness following unprepared full colonoscopy with biopsy. In laboratory tests leukocytosis with a shift to left and coagulopathy were reported. CT scan showed multiple pyogenic liver abscesses. The patient received broad-spectrum intravenous antibiotics and hydration, but after 96 hours, the patient did not respond to supportive treatment and died due to septic shock. Methicillin-resistant staphylococcus aureus was reported in blood culture. Conclusion: Although colonoscopy is a convenient and relatively safe diagnostic procedure, doctors should always consider rare complications of colonoscopy, especially in patients with risk factors such as diabetes mellitus, immunodeficiency and malignancies of the liver and liver transplantation. In addition, complete colonoscopy and other diagnostic procedures such as biopsy or polypectomy in patients with inadequate bowel preparation for colonoscopy should be avoided.