Recurrent liver abscess secondary to ingested fish bone migration: report of a case

[Recurrent bacterial abscess of the left liver lobe caused by a foreign body (fish bone)]

The authors present minimally invasive surgical treatment of recurrent liver abscess caused by migration of fish bone from the upper gastrointestinal tract. Two-stage treatment implied small-caliber transparietal drainage of abscess with evacuation of purulent detritus at the first stage. At the second stage, primary percutaneous approach was transformed into access of sufficient diameter for flexible or rigid optics for visually controlled bone extraction. Foreign body removal through the drainage tube with endoscopic capture under visual control is preferable regarding safety compared to removal under ultrasound and/or X-ray control. Indeed, endoscopic approach is valuable for optimal positioning of the object and prevention of damage to liver parenchyma during extraction.

[A CASE OF PERIVESICAL ABSCESS CAUSED BY MIGRATION OF A FOREIGN BODY FROM THE INTESTINAL TRACT]

A 76-year-old woman was referred to our department because of high fever and bladder irritative symptoms. Computed tomography revealed the presence of a heterogeneous mass with indistinct borders on the left anterior wall of the bladder. The lesion contained a linear hyperdense shadow. We initially suspected malignancy, such as urachal carcinoma or soft-tissue sarcoma. However, upon review of previous computed tomography scans, it was confirmed that the linear hyperdense shadow had migrated from the intestinal tract to the bladder. Considering the possibility of abscess formation caused by a foreign body, we decided to perform a transurethral biopsy. The results of the pathological analysis showed abscess formation. The patient was diagnosed with perivesical abscess caused by accidental ingestion of a fish bone. Following the administration of antibiotics, the lesion markedly shrank. Although it is difficult to distinguish perivesical abscess from malignant disease, invasive treatment can be avoided by appropriate diagnosis based on imaging studies.

Hepatic resection due to a fish bone

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Hepatic abscess due to a foreign body is rare.

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Diagnosis is difficult since symptoms are non-specific.

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Stomach and duodenum are the common sites of perforation.

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Antibiotics with abscess drainage and foreign body removal is the most frequently used treatment.

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Hepatic resection is rarely needed, but surgeons must be aware of its possibility.

Introduction and importance

Hepatic abscess due to foreign body is rare. Diagnosis is difficult and drainage may not be enough. Hepatic resection may be indicated.

Case presentation

A 76yo male patient resorted to the emergency room because of fever and abdominal pain. Abdominal CT diagnosed a hepatic abscess in the left lobe due to a fishbone. Percutaneous and surgical drainage failed. Laparotomic hepatic resection was necessary. The patient was discharged asymptomatic.

Clinical discussion

Liver abscess due to foreign body usually occur in the left lobe. Drainage and removal of the foreign body are mandatory and can be achieved either by percutaneous or surgical drainage. Resection is rarely indicated but sometimes is the only way. The authors found only ten cases of hepatic resection due to pyogenic abscess because of a foreign body.

Conclusions

Hepatic resection is rarely needed to treat a pyogenic abscess, but surgeons must be aware and able to proceed with it.

Retained Foreign Body Causing a Liver Abscess

Introduction

A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department.

Case Report

We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ.

Conclusion

This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.

Liver abscess caused by fish bone perforation of stomach wall treated by laparoscopic surgery: a case report

Background

Formation of a liver abscess due to gastrointestinal perforation by a foreign body is rare. In addition, there are few case reports on laparoscopic surgical treatment of a liver abscess caused by perforation of the gastrointestinal tract by a foreign body.

Case presentation

A 51-year-old man visited our hospital because of fever and anorexia. There were no physical findings except for fever. He had no comorbidities or surgical history. Laboratory tests showed increased inflammatory marker and liver enzyme levels. Abdominal ultrasonography showed a hypoechoic lesion in the left lobe of the liver. Abdominal contrast-enhanced computed tomography revealed an air-containing abscess in the left side of the liver and a high-density linear object. We diagnosed a liver abscess secondary to stomach perforation by a foreign body. Emergency laparoscopic surgery identified a fish bone in the abscess that formed between the stomach and liver. We succeeded in removing the fish bone laparoscopically.

The patient was discharged without any postoperative complications on day 11.

Conclusions

A liver abscess secondary to perforation of the gastrointestinal tract by a foreign body usually requires surgical treatment. Foreign body removal is important to prevent recurrence of liver abscess. In cases with the foreign body located at the liver margin, a laparoscopic approach to the abscess is very useful.

Hepatic Abscess due to Streptococcus anginosus and Eikenella corrodens, Secondary to Gastric Perforation by a Fish Bone

Introduction

Foreign-body ingestion is a common event, but in only less than 1% of the cases complications occur. Hepatic abscesses induced by foreign-body penetration are rare. To date, there are only 62 reported cases of hepatic abscess secondary to fish bone perforation of the gastrointestinal tract.

Case Presentation

A 78-year-old male patient was admitted due to high fever and vomiting for 2 days, along with frequent eructations for the past 3 months. Abdominal ultrasound showed a liver abscess in the left lobe, and computed tomography revealed a hyperdense linear image that crossed the superior wall of the gastric antrum, contacting the liver lesion, suggestive of a foreign body, probably a fish bone. Blood cultures were positive with isolation of Streptococcus anginosus and Eikenella corrodens. Ultrasound-guided percutaneous drainage of the abscess was done, and S. anginosus was isolated in the pus. Surgical debridement and fish bone removal were performed; the patient completed 21 days of antibiotic therapy, with a favorable evolution.

Conclusion

To the best of our knowledge, this is the first reported case of liver abscess caused by fish bone penetration with isolation of S. anginosus and E. corrodens. Bacterial coaggregation is one of the mechanisms that can explain their ability for causing invasive infections away from the oral cavity, by increasing their resistance to the innate immune system and survival of both species.

Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review

RATIONALE

Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare.

PATIENT CONCERNS

A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months.

DIAGNOSIS

A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy.

INTERVENTIONS

The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length.

OUTCOMES

The patient recovered uneventfully and was discharged on day 5 after surgery.

LESSONS

This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.

A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore

INTRODUCTION

Ingestion of fish bones is a common clinical complaint among adult patients. The aim of this study was to evaluate the epidemiological and behavioural risk factors for fish bone ingestion.

METHODS

Between 2009 and 2010, a physician-administered questionnaire was administered to 112 consecutive patients who presented to the emergency department of an adult tertiary hospital with the complaint of fish bone ingestion.

RESULTS

The wearing of dentures, the use of utensils to eat fish and the practice of deboning fish in one's mouth were found to be associated with an increased risk of fish bone ingestion.

CONCLUSION

To prevent the occurrence of fish bone ingestion and its possible complications, at-risk populations should be advised on the precautions to take when eating boned fish.

Method to measure the force to pull and to break pin bones of fish

A texture measurement device was modified to measure the force required to pull pin bones from King salmon (Oncorhynchus tshawytscha), snapper (Pagrus auratus), and kahawai (Arripis trutta). Pulled bones were also subjected to tension to measure the breaking force. For all fish, the pulling force depended on the size of the fish, and on the length of the pin bone (P < 0.05). In general, larger fish required greater pulling force to remove pin bones. For example, fresh small salmon (about 1500 g whole) required 600 g on average to pull pin bones, and large fish (about 3700 g whole) required 850 g. Longer bones required greater pulling force. The breaking force followed the same trend. In general, the breaking force was greater than the pulling force. This allows the removal of the bones without breaking them. There was no statistically significant (P > 0.05) difference between the forces (both pulling and breaking) from fresh and frozen/thawed samples, although in general frozen/thawed samples required less force to pull. With the quantification of pulling and breaking forces for pin bones, it is possible to design and build better, "more intelligent" pin bone removal equipment.

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review

Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.

Recurrent upper quadrant pain: a fish bone secondary to gastric perforation and liver abscess

A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT) showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.

An unusual zoonosis: liver abscess secondary to asymptomatic colonic foreign body

A liver abscess may arise following any insult to gut integrity allowing portal drainage of bacteria to hepatocytes. Foreign bodies such as bones, toothpicks and items of stationery have previously been implicated in compromising gut epithelium. Here we present the case of a 57 year old man suffering from a left liver abscess. This was defined on CT which incidentally also identified a chicken bone protruding through the wall of the distal sigmoid colon. Whilst unwell with upper abdominal pain and sepsis, the presumed source of portal sepsis within the colon remained asymptomatic throughout. Following percutaneous drainage, the liver abscess resolved but the chicken bone had not passed at two months, necessitating atraumatic removal at colonoscopy. A high rate of incidental diagnoses suggests that unidentified foreign bodies may be vastly under recognised in cases of hepatic sepsis. Thus, identification of the precise mechanism of the liver insult demands thorough consideration; foreign body should be considered in all cases.

Fish bone penetration of the duodenum extending into the pancreas: report of a case

We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas.

Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and Central Europe

Knowledge of etiology and timely treatment of underlying causes, when possible, play an important role in the successful therapy of patients with pyogenic liver abscess (PLA). Recent publications from Central Europe and Southeast Asia hint at considerable differences in etiology. In this article, we aim to elaborate these differences and their therapeutic implications. Apart from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA), there are clear differences in the microbiological spectrum, which implies different risk factors and disease courses. Klebsiella pneumoniae (K. pneumoniae) PLA is predominantly seen in Southeast Asia, whereas, in Central Europe, PLA is typically caused by Escherichia coli, Streptococcus or Staphylococcus, and these patients are more likely to be older and to have a biliary abnormality or malignancy. K. pneumoniae patients are more likely to have diabetes mellitus. Control of septic spread is crucial in K. pneumoniae patients, whereas treatment of the underlying diseases is decisive in many Central European PLA patients.