A 67-year-old man with controlled diabetes was admitted to the hospital with a 1-week history of abdominal pain, fever (38 °C), and hematochezia. Physical examination revealed severe tenderness in the right upper quadrant of the abdomen. Computed tomography of the abdomen showed multiple lobulated masses with gas formation in the liver (arrowhead) with portal vein gas and perforation of the proximal transverse colon with ascending colon cancer (arrow, Panel A). The patient underwent an emergency laparotomy with right hemicolectomy, which revealed multiple and palpable mass in the liver. The cultured blood samples were positive for Clostridium septicum. Bacterial invasion to portal vein caused the pyogenic liver abscesses. He was treated with ceftriaxone and metronidazole. Follow-up imaging represented reduction in the liver abscesses size (arrowhead, Panel B). The patient was diagnosed with stage IVA (T3N2M1) colon adenocarcinoma and is currently undergoing postoperative chemotherapy. With an appropriate antibiotic regimen, his clinical condition improved. However, he was died due to septic shock with liver abscess after 6 months.