S938 Abstracts

intraabdominal bowel contents with subsequent spread to liver via the portal circulation or in the setting
of biliary infection via direct spread. Hepatic abscess secondary to penetrating foreign body from the
gastrointestinal tract is a rare finding. 80%-90% of ingested foreign bodies pass through the gut within
one week without discovery by the patient without any complications. If the foreign body does not pass,
treatment may lead to perforation, and in our patient hepatic abscess, require intervention by gastroen-
terology, interventional radiology, and surgical teams. Case: We report case of a 55 years old man who
presented with sepsis and abdominal pain. On CT scan, he was found to have left liver lobe abscess, and
a sharp foreign body locating in the stomach adjacent to collection. Patient denied ingestion of any bones
or sharp objects. Interventional radiology guided drainage of the abscess was performed, however patient
continued to exhibit signs of peritonitis and was taken to the operating room for removal of the foreign
body and closure of the perforation. Foreign body was determined to be a 4 cm fish bone. Discussion:
The most common areas of perforation by foreign body are the ileocecal, rectosigmoidal regions, and
duodenum. However the most common site of hepatic abscess secondary to perforating foreign body
is the stomach. Typical cases of liver abscess present fever and abdominal pain, jaundice is present in a
small percentage of patients. Most patients present non-specific symptoms. The foreign body's migration
is usually silent for a long time and is discovered only if there is infection or abscess. Foreign body is fre-
quently lodged in the left lobe of the liver. The diagnosis of the choice is CT scan. In this paper, we review
this patients case and images and review the available literature on liver abscess secondary to foreign
body from gastrointestinal tract. Hepatic abscess remains a difficult problem. The principal of timely
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diagnosis and prompt treatment of this disease will decrease its morbidity and mortality.

[1964A] Figure 1.

[1965A] Figure 1.

[1964B] Figure 2.

to the retinol form, and therefore causing hepatotoxicity. Vitamin A toxicity can present as a cholestatic
hepatotoxicity and must be considered in the appropriate clinical scenario and is usually diagnosed by
liver biopsy only.

1965
Penetrating Foreign Body Causing a Large Hepatic Abscess: A Case Report and Review [1965B] Figure 2.
Negar Niknam, MD, Kaveh Zivari, MD, Kadirawelpillai Iswara, MD, FACLP, FACG, AGAF, Rabin
Rahmani, MD. Maimonides Medical Center, Brooklyn, NY.

Introduction: Pyogenic hepatic abscesses are the most common type of visceral abscess with mortality
rate in developed countries ranges from 2 to 12 percent. The pyogenic abscess is often due to leakage of

The American Journal of GASTROENTEROLOGY VOLUME 111 | SUPPLEMENT 1 | OCTOBER 2016 www.nature.com/ajg

[1965C] Figure 3.
1966
Oral Contraceptive-Associated Hepatitis
Ansa Anderson, BSc1, Yana Cavanagh, MD2, Pavel Yasyulyanets3, Jill Butler, MD3, Walid Baddoura, MD4.
1. St. George’s University, Elizabeth, NJ; 2. St. Joseph’s Regional Medical Center, Paterson, NJ; 3. Trinitas
Regional Medical Center, Elizabeth, NJ; 4. St. Joseph Regional Medical Center, Paterson, NJ.
Oral contraceptive pills are a popular means of pregnancy prevention with a lifetime prevalence (among
women ages 15-44) as high as 88%. Due to this high utilization rate, it is important to understand the
side effect profiles associated with these agents. Among the various effects, hepatic complications can
include hepatic dysfunction, cholestatic jaundice as well as benign and malignant hepatic tumors. A
22-year-old female with a past medical history of asthma presented with 10-days of progressive dull right
upper quadrant abdominal pain, nausea/vomiting, and dizziness accompanied by syncope. On physical
[1966A] Figure 1.
© 2016 by the American College of Gastroenterology
Abstracts S939
[1966B] Figure 2.
[1966C] Figure 3.
examination our patient was positive for orthostatic hypotension with accompanying epigastric and right
upper quadrant tenderness. Liver function studies showed elevated AST of 318 U/L and ALT of 717 U/L,
and acetaminophen level of 3.1 ug/ml. Her hepatitis panel was negative for anti-mitochondrial antibody
as well as hepatitis A, B or C. An ultrasound of her abdomen revealed a coarse hepatic echotexture,
which indicated chronic hepatic inflammation. Upon discontinuation of her oral contraceptive pill her
laboratory aberrancies and presenting symptomatology resolved. Case reports such as Chaudhary et.
al describe associations between oral contraceptive pills and hepatic injury. Estrogen has been linked
to hepatotoxicity, more commonly cholestasis especially in pregnant women, those taking oral contra-
ceptive pills or post-menopausal hormonal therapy. Although the exact pathophysiology of estrogen
induced hepatic dysfunction remains unclear, estrogen receptor alpha-mediated pathologies have been
reported. A heightened clinical awareness should be maintained that not all widely observed associations
are compulsively reported in drug package inserts or side effect profiles. It is important for physicians
to recognize that hepatitis in oral contraceptive users could be severe and may require hospitalization.
In light of this case, and the prevalence of hepatic effects of oral contraceptive pills, it is important for
physicians to be aware of oral contraceptive associated hepatitis.
1967
Paraneoplastic Hypoglycemia in Hepatocellular Carcinoma: A Paucity of Treatments
Alberto Gavilanes, MD1, Yana Cavanagh, MD2, Michelle Cholankeril, MD1. 1. Trinitas Regional Medical
Center, Elizabeth, NJ; 2. St. Joseph’s Regional Medical Center, Paterson, NJ.
Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer worldwide. Up to one third of patients
with HCC can develop paraneoplastic hypoglycemia. Two distinct types have been described: Type A
occurs with rapidly growing tumors while Type B results from non-islet cell tumors by overstimulation
of insulin receptors via IGF2. The management of paraneoplastic hypoglycemia remains challenging due
to variable responses among patients. A 35-year-old Haitian male with a six-month history of advanced
HCC-post one dose of sorafenib, presented with intractable nausea/vomiting and severe hypoglycemia
despite aggressive supportive management with intravenous glucose infusion. Physical examination
revealed a large protruding mass in the epigastrium, cachexia, lower extremity edema and an ECOG per-
formance status of 4. He had no history of alcohol abuse or toxin exposure. Ancillary testing was negative
for Hepatitis B, C or other active liver disease. His alpha-fetoprotein was >300,000 ng/mL, while C-pep-
tide, insulin and IGF-I levels were suppressed. An abdominal CT scan revealed a predominant hepatic
mass occupying the entire left lobe and caudate lobe of the liver complicated by portal vein thrombosis.
The mass measured 21x21 cm in transverse and craniocaudal dimensions and had increased in size as
compared to a prior imaging. Our patient’s hypoglycemia was refractory to various inpatient therapeu-
tic strategies including administration of glucocorticoids, counter regulatory hormones, and diazoxide.
In an attempt to further palliate symptoms, two bland embolizations as well as one chemoemboliza-
tion of the left hepatic artery were performed without success. Hospice care was recommended based
on the patient’s advanced stage, however he declined. Multiple palliative approaches were attempted to
reduce overall tumor burden that most likely led to his severe hypoglycemia however were not fruitful
in decreasing hypoglycemic events. His tumor burden was observed to correlate to the high degree of
resistance to available treatment options. Ultimately, the patient succumbed to a cardiac arrhythmia and
expired. This case describes a rare paraneoplastic syndrome, which can be seen in HCC, and the chal-
lenges associated with its treatment. This unusual cause of HCC associated mortality establishes that
effective treatment modalities should be further investigated for paraneoplastic hypoglycemia in HCC.
The American Journal of GASTROENTEROLOGY