Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report
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Case report
Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report Alberta Ferrari*, Ivan Botrugno, Elisa Bombelli, Tommaso Dominioni, Emma Cavazzi and Paolo Dionigi Address: Department of Surgery, University of Pavia, Istituto di Chirurgia Epatopancreatica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Email: Alberta Ferrari* - [email protected]; Ivan Botrugno - [email protected]; Elisa Bombelli - [email protected]; Tommaso Dominioni - [email protected]; Emma Cavazzi - [email protected]; Paolo Dionigi - [email protected] * Corresponding author
Published: 12 May 2008 World Journal of Surgical Oncology 2008, 6:49
doi:10.1186/1477-7819-6-49
Received: 8 January 2008 Accepted: 12 May 2008
This article is available from: http://www.wjso.com/content/6/1/49 © 2008 Ferrari et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Even though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet. Case presentation: We describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1). After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared. Conclusion: As this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.
Background A well-recognized relationship has been established between unusual bacterial infections and neoplastic lesions of the colon. Although several bacteria have been reported in association with colonic cancer, the strongest and best documented relationship focuses on Streptococcus bovis [1,2]. Streptococcus bovis is classified as a non-enterococcal Streptoco
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