male , 72-year - old , morbidly obese , diabetic , admitted for abdominal pain , prostration and fever that started last 3 days . abdominal ultrasound and abdominal computed tomography scan showed liver injury in the transition of v and vi segments measuring 8.4 cm . due to the possibility of liver abscess , initiate empirical antibiotic therapy with ampicillin and sulbactam and metronidazole and performed ultrasound - guided percutaneous drainage of liver injury . new percutaneous drainage with the same results . we opted for performing endoscopic ultrasound ( eus ) with fine - needle aspiration ( fna ) . immunohistochemistry suggestive of metastasis of the lower gastrointestinal tract . due this finding , realized colonoscopy , which revealed a vegetating lesion with central ulceration , bleeding , filling almost the entire cecum . patient was referred for surgical resection of the bowel tumor , which showed moderately differentiated adenocarcinoma infiltrating vegetative and possibly originated from villous adenoma with high - grade dysplasia . the finding of metastatic liver abscess of colonic neoplasia is not common . in most cases , the material from the abscess drainage allows the diagnosis , but in this case , even after two ultrasound - guided percutaneous drainage was not obtained conclusive bacteriological or histopathological . opted for new puncture through eus , which allowed definitive diagnosis of the condition .
introduction : male , 72-year - old , morbidly obese , diabetic , admitted for abdominal pain , prostration and fever that started last 3 days . 
 abdominal ultrasound and abdominal computed tomography scan showed liver injury in the transition of v and vi segments measuring 8.4 cm . due to the possibility of liver abscess , 
 initiate empirical antibiotic therapy with ampicillin and sulbactam and metronidazole and performed ultrasound - guided percutaneous drainage of liver injury . 
 negative for malignant cells , with the presence of leukocytes and negative culture . 
 after 2 weeks of treatment , take control image without changing the lesion dimension . 
 new percutaneous drainage with the same results . we opted for performing endoscopic ultrasound ( eus ) with fine - needle aspiration ( fna ) . 
 fna pathology : moderately differentiated adenocarcinoma . 
 immunohistochemistry suggestive of metastasis of the lower gastrointestinal tract . due this finding , realized colonoscopy , which revealed a vegetating lesion with central ulceration , bleeding , filling almost the entire cecum . 
 patient was referred for surgical resection of the bowel tumor , which showed moderately differentiated adenocarcinoma infiltrating vegetative and possibly originated from villous adenoma with high - grade dysplasia.discussion:the finding of metastatic liver abscess of colonic neoplasia is not common . in most cases , 
 the material from the abscess drainage allows the diagnosis , but in this case , even after two ultrasound - guided percutaneous drainage was not obtained conclusive bacteriological or histopathological 
 . opted for new puncture through eus , which allowed definitive diagnosis of the condition.conclusion:metastatic colon neoplasm should be considered in cases of differential diagnosis of liver abscess .