An Uncommon Communication: Hepatogastric Fistula in a Young Male Patient With a Pyogenic Liver Abscess

Hepatogastric fistula is a rare complication of pyogenic liver abscess, occurring when a left-lobe abscess erodes through the gastric wall.We describe the case of a 26-year-old male who presented with a two-week history of fever, vomiting, and epigastric pain, following a brief hospitalization elsewhere where conservative management failed to control his symptoms; he was anemic at presentation and had pus in the vomitus.Ultrasonography demonstrated a heterogeneous collection in the left hepatic lobe containing multiple air foci, with apparent communication with the adjacent stomach.Contrast-enhanced computed tomography (CT) confirmed a large, thick-walled hypodense lesion in the left hepatic lobe with focal wall discontinuity and a fistulous tract (~2.7 cm) extending to the gastric lesser curvature, with visible passage of air between the abscess cavity and stomach, findings consistent with a ruptured liver abscess complicated by hepatogastric fistula.Ultrasound-guided fine-needle aspiration yielded blood and neutrophilic debris, supporting the diagnosis of a liver abscess.Magnetic resonance cholangiopancreatography (MRCP) subsequently confirmed the fistulous communication while excluding involvement of the biliary tree.The patient was managed conservatively with intravenous antibiotics and blood transfusion for anemia, without any drainage or surgical intervention.His clinical course was uneventful, and follow-up contrast-enhanced CT at approximately seven weeks showed a significantly reduced residual collection with no residual fistulous communication with the stomach.Upper gastrointestinal endoscopy performed at nearly five months confirmed complete mucosal healing, with entirely normal endoscopic findings.This case demonstrates that a hepatogastric fistula secondary to a pyogenic liver abscess can resolve with antibiotic therapy alone, without the drainage or surgical intervention required in several previously reported cases, when supported by close clinical and imaging follow-up.