1
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Dev S, Yadav M, Shah NA, Dev B, Devkota S, Khadka L, Das DK, Yadav S, Sah JK, Ghimire B. A rare case of retained metallic foreign body in liver: case report and review of literature. Ann Med Surg (Lond) 2024; 86:3159-3164. [PMID: 38694309 PMCID: PMC11060318 DOI: 10.1097/ms9.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance Foreign bodies in the liver are uncommon but can lead to severe conditions like liver abscess and sepsis. They typically enter through direct penetration, migration from the gastrointestinal tract, or through the blood. Common foreign objects include metal pins, or sewing needles swallowed accidentally. Case presentation A 25-year-old male presented to our OPD with pain over the right abdomen with a prior history of projectile injury causing laceration over the right anterior abdomen with primary suturing. On radiological investigation, a retained foreign body was revealed. The metallic foreign body was embedded in the liver for 5 months. Removal of the foreign body was performed without any complications. Clinical discussion Intrahepatic foreign bodies (FBs) in the liver can result from penetrating injuries, iatrogenic causes, or ingestion, particularly in children. Clinical presentations vary, and complications such as abscess formation may occur. Diagnosis involves imaging modalities like X-rays, ultrasonography, and computed tomography (CT) scans. The presented case highlights the importance of meticulous follow-up, as chronic pain manifested despite conservative management. The management of intrahepatic FBs depends on factors like size, location, and symptoms, with conservative approaches for stable patients. Surgical removal remains the mainstay of the treatment. Long-term monitoring is crucial to detect potential complications, and imaging studies play a key role in regular follow-up. Conclusion Hepatic foreign bodies are rare, and symptoms vary based on size, type, and location, ranging from asymptomatic to complications such as abscess formation. Surgical removal is the main treatment, but in cases of noncomplicated hepatic foreign bodies, close follow-up is necessary.
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Affiliation(s)
| | | | | | - Barsha Dev
- Nepalgunj Medical College Teaching Hospital, Kohalpur
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2
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Taieb AH, Chaouch MA, Kaouach A, Ben Jabra S, Zayati M, Gafsi B, Mili E, Noomen F. An uncommon liver abscess secondary to an ingested foreign body: A case report. IDCases 2024; 36:e01934. [PMID: 38601431 PMCID: PMC11002799 DOI: 10.1016/j.idcr.2024.e01934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.
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Affiliation(s)
- Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Aymen Kaouach
- Department of General Surgery, Sidi Bouzid Hospital, Sidi Bouzid, Tunisia
| | - Sadok Ben Jabra
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Emna Mili
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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3
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Kadi A, Tuergan T, Abulaiti Y, Shalayiadang P, Tayier B, Abulizi A, Tuohuti M, Ahan A. Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report. World J Clin Cases 2022; 10:13402-13407. [PMID: 36683634 PMCID: PMC9850996 DOI: 10.12998/wjcc.v10.i36.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/28/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.
CASE SUMMARY This report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient's general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory.
CONCLUSION PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.
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Affiliation(s)
- Abudureyimu Kadi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yierpan Abulaiti
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Paizula Shalayiadang
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Baihetiyaer Tayier
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Abududuaini Abulizi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Muniremu Tuohuti
- Department of General Medicine, First People's Hospital of Aksu Region, Aksu 843099, Xinjiang Uygur Autonomous Region, China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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4
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Barrie J, Lobo DN. A pen in the liver. Radiol Case Rep 2022; 17:3992-3995. [PMID: 36032213 PMCID: PMC9403883 DOI: 10.1016/j.radcr.2022.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
A 24-year-old woman with anxiety, depression, and emotionally unstable personality disorder was referred to a tertiary center 2 weeks after ingesting multiple foreign bodies. She had undergone a laparoscopic cholecystectomy and a laparotomy for extraction of ingested foreign bodies several years ago. A sagittal CT scan view showed a ballpen and a hair clip in the stomach. A coronal view demonstrated that a second ballpen had penetrated the duodenal wall to enter the liver parenchyma. There was no free intraperitoneal air or fluid or evidence of abscess formation. At laparotomy, a toothbrush, a broken spoon and a ballpen were extracted from the stomach via an anterior gastrotomy. The duodenum was adherent to the liver but the second ballpen had migrated into the distal duodenum, with the tip in the proximal jejunum. This was extracted via an enterotomy and the fistula was not interfered with. The enterotomy and gastrotomy were closed with 3-0 polydioxanone sutures. The hair clip had passed spontaneously and was not detected on intraoperative fluoroscopy. She made an uneventful recovery and postoperative liver function tests remained in the normal range. This is only the fourth reported case of a pen fistulizing between the upper gastrointestinal tract and the liver.
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Affiliation(s)
- Jenifer Barrie
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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5
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Basin M, Dimmer A, Abramyan S, Tewari SO, Lucia A. Percutaneous extraction of metallic foreign body from pyogenic liver abscess. J Surg Case Rep 2022; 2022:rjac349. [PMID: 35967835 PMCID: PMC9371894 DOI: 10.1093/jscr/rjac349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
We report a case of a 35-year-old male who developed a pyogenic liver abscess (PLA) secondary to a foreign body that migrated from the transverse colon into the liver. The mainstay of treatment of PLA requires removal of the foreign body, most frequently performed surgically. Few case reports exist of percutaneous removal. As our patient was hemodynamically stable at time of presentation, he underwent successful percutaneous transhepatic removal of the foreign body, avoiding any need for surgical operation.
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Affiliation(s)
- Michael Basin
- SUNY Upstate Medical University , Syracuse, NY , USA
| | | | | | | | - Amie Lucia
- SUNY Upstate Medical University , Syracuse, NY , USA
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6
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Bsat A, Ataya K, Osman B, Hafez B, Kanafani D, Hallak R, Khalife MJ. Indirect ballistic injury to the liver resulting in retained bullet complicated with hepatic abscess: a case report. J Surg Case Rep 2022; 2022:rjac261. [PMID: 35873188 PMCID: PMC9300046 DOI: 10.1093/jscr/rjac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Indirect and extraperitoneal penetrating liver injury is an extremely uncommon phenomenon. In this report, we highlight the case of an 18-year-old male patient that sustained a gunshot wound with an entry site through the right buttock and landed in the liver. He presented to us in sepsis due to developing a hepatic abscess at the site of the dislodged bullet that was confirmed with computed tomography. Interestingly, the ballistic missile did not cause any visceral injury due to its indirect and extraperitoneal trajectory. The patient underwent diagnostic laparoscopy, where the hepatic abscess was unroofed and evacuated. A free-floating bullet was found and extracted, and a small bile duct leak was repaired. The patient had an uneventful post-operative course and was duly discharged on an empiric course of antibiotics.
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Affiliation(s)
- Ayman Bsat
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Karim Ataya
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Bassam Osman
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Basel Hafez
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Dana Kanafani
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
| | - Razan Hallak
- Department of Neurology, American University of Beirut Medical Center , Beirut , Lebanon
| | - Mohamad Jawad Khalife
- Department of General Surgery, American University of Beirut Medical Center , Beirut , Lebanon
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7
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Zhao G, Zhao S, Wang S, Liu X, Qi Q, Li Y, Zuo M. Unexpected death from hepatic abscess 16 months after toothbrush ingestion. J Forensic Sci 2022; 67:2110-2114. [PMID: 35699092 DOI: 10.1111/1556-4029.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
The development of a hepatic abscess secondary to foreign body (FB) ingestion remains rare in forensic practice. Herein, we present a case of a prisoner who died in the hospital and a forensic autopsy was performed to confirm the cause of death. A 14.5-cm-long toothbrush handle was found in the duodenum and had penetrated the right lobe of the liver, consistent with the repeated abdominal pain in his clinical history. The clinical history and investigation confirmed that he had ingested the toothbrush handle 16 months prior. This case highlights a rare complication of intentional ingestion of foreign bodies, and pathologists should be aware of this rare entity which links hepatic abscess and FB ingestion.
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Affiliation(s)
- Guoting Zhao
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
| | - Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Songjun Wang
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
| | - Xia Liu
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
| | - Qian Qi
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
| | - Yingmin Li
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
| | - Min Zuo
- Department of Forensic Medicine, Identification Center of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang, China
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8
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Kehagias D, Mulita F, Maroulis I, Benetatos N. Caudate lobe: the last barrier - an unusual place for a foreign body. ANZ J Surg 2022; 92:1218-1220. [PMID: 34550639 DOI: 10.1111/ans.17226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, Achaia, Greece
| | - Francesk Mulita
- Department of General Surgery, General University Hospital of Patras, Achaia, Greece
| | - Ioannis Maroulis
- Department of General Surgery, General University Hospital of Patras, Achaia, Greece
| | - Nikolaos Benetatos
- Department of General Surgery, General University Hospital of Patras, Achaia, Greece
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9
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Yan TD, Leung PHY, Zwirewich C, Harris A, Chartier-Plante S. An unusual cause of pericardial effusion: A case report of a hepatic abscess following foreign body migration and duodenal perforation. Int J Surg Case Rep 2022; 93:106931. [PMID: 35279521 PMCID: PMC8924627 DOI: 10.1016/j.ijscr.2022.106931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Although foreign bodies are a rare cause of gastrointestinal tract perforation, they may serve as a nidus for hepatic abscess. Abdominal pain is the most common presenting symptom. We present a case of an ingested pen causing duodenal perforation and hepatic abscess several months after initially presenting with a pericardial effusion. CASE PRESENTATION A 59-year-old female living in an intensive tertiary mental health facility was noted to have an incidental pericardial effusion during work-up for hyponatremia. Seven months later, she developed a new fever and was noted to have interval increase in the pericardial effusion size. This prompted further investigation which finally revealed that an ingested pen had perforated through the first part of the duodenum and caused an abscess in the left lobe of the liver. The pericardial effusion was presumed secondary to local inflammation. Upon discovery of the abscess, the patient underwent successful operative management including abscess drainage, foreign body extraction, and duodenal repair. CLINICAL DISCUSSION Reports of hepatic abscess from foreign body causing duodenal perforation are rare, with bone fragments and toothpicks the most common foreign bodies implicated. There is one other previously reported case of an ingested pen. Abdominal pain is present in up to 85% of cases, but fever may be the only presenting symptom. CONCLUSION Foreign body migration causing a hepatic abscess may present non-specifically with unexplained fever or even pericardial effusion. Psychiatric comorbidities may contribute to delays in diagnosis due to difficulties recalling the episode of ingestion.
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Affiliation(s)
- Tyler D Yan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Philemon H Y Leung
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Charles Zwirewich
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Alison Harris
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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10
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Swenson AL, Lipman GS, Garcia ECM. Woman with abdominal pain and fever. J Am Coll Emerg Physicians Open 2022; 3:e12701. [PMID: 35280922 PMCID: PMC8897659 DOI: 10.1002/emp2.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Grant S. Lipman
- Department of Emergency Medicine O'Connor Hospital San Jose California USA
| | - Eddie C. M. Garcia
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
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11
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Xia F, Zhu P, Chen XP, Zhang BX, Zhang MY. Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report. BMC Surg 2022; 22:6. [PMID: 34996410 PMCID: PMC8741587 DOI: 10.1186/s12893-021-01457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare. Case presentation A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications. Conclusions Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01457-z.
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Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Peng Zhu
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China.
| | - Xiao-Ping Chen
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Bi-Xiang Zhang
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Ming-Yu Zhang
- Department of Digestive Medical, Tongji Hospital of Tongji Medical College in Huazhong University of Science and Techology, Wuhan, Hubei, China
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12
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Nassif AT, Granella VH, Rucinski T, Cavassin BL, Bassani A, Nassif LT. Laparoscopy treatment of liver abscess secondary to an unusual foreign body (rosemary twig). AUTOPSY AND CASE REPORTS 2021; 11:e2021317. [PMID: 34458185 PMCID: PMC8387063 DOI: 10.4322/acr.2021.317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022] Open
Abstract
A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.
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Affiliation(s)
- André Thá Nassif
- Hospital Santa Casa de Curitiba, Department of General Surgery, Curitiba, PR, Brasil
| | - Victor Hugo Granella
- Hospital Santa Casa de Curitiba, Department of General Surgery, Curitiba, PR, Brasil
| | - Tulio Rucinski
- Hospital Santa Casa de Curitiba, Department of General Surgery, Curitiba, PR, Brasil
| | - Bruno Landal Cavassin
- Pontifícia Universidade Católica do Paraná, School of Medicine, Curitiba, PR, Brasil
| | - Alesandra Bassani
- Hospital Santa Casa de Curitiba, Department of General Surgery, Curitiba, PR, Brasil
| | - Lucas Thá Nassif
- Hospital Santa Casa de Curitiba, Department of General Surgery, Curitiba, PR, Brasil
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13
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Pan W, Lin LJ, Meng ZW, Cai XR, Chen YL. Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging: A case report. World J Clin Cases 2021; 9:6781-6788. [PMID: 34447825 PMCID: PMC8362509 DOI: 10.12998/wjcc.v9.i23.6781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract. Esophageal-lodged foreign bodies can cause secondary injury or detrimental response, with hepatic abscess being one such, albeit rare, outcome. Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.
CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever. Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver (7.8 cm × 6.0 cm × 5.0 cm). Initially, a malignant tumor was suspected, but differential diagnosis was unable to exclude the possibility of hepatic abscess. Conservative anti-infection therapy produced a less than ideal outcome. Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess, and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb. Therefore, surgery was performed to remove the object (fishbone) and drain the abscess. After a 2-wk uneventful recovery, the patient was discharged. The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.
CONCLUSION Differential diagnosis is important for hepatic masses, and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.
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Affiliation(s)
- Wei Pan
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Li-Jing Lin
- Department of Endocrinology, Union Hospital, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ze-Wu Meng
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Xin-Ran Cai
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Yan-Ling Chen
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
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14
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Beckers G, Magema JP, Poncelet V, Nita T. Successful laparoscopic management of a hepatic abscess caused by a fish bone. Acta Chir Belg 2021; 121:135-138. [PMID: 31433267 DOI: 10.1080/00015458.2019.1658353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hepatic abscess is a rare condition but comes with heavy consequences if not diagnosed and managed properly. Early detection of this pathology is challenging because of the variety and lack of specificity of symptoms but is necessary for accurate management. CASE REPORT We report a case of pyogenic liver abscess secondary to the migration of an ingested fish bone in a 74-year-old female. We used laparoscopic surgery to drain the abscess, remove the foreign body responsible and look for the perforation site. Parenteral antibiotherapy was added to the surgical treatment. CONCLUSION Early diagnosis of hepatic abscess caused by the migration of a foreign body remains a challenge. In our opinion, laparoscopic surgery associated with antibiotics is the safest and most effective therapeutic option.
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Affiliation(s)
- G. Beckers
- Abdominal Surgery Department, CHU-UCL Namur, Dinant, Belgium
| | - J.-Ph. Magema
- Abdominal Surgery Department, CHU-UCL Namur, Dinant, Belgium
| | - V. Poncelet
- Radiology Department, CHU-UCL Namur, Dinant, Belgium
| | - T. Nita
- Infectiology Department, CHU-UCL Namur, Dinant, Belgium
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15
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Hoff JW, Castrisos G, Sivasuthan G, Renwick C. Laparoscopic Management of Hepatic Abscess From Ingested Chicken Bone. Cureus 2021; 13:e13403. [PMID: 33758700 PMCID: PMC7978156 DOI: 10.7759/cureus.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A 68-year-old man presented to the hospital with severe right upper abdominal pain, fevers, nausea and lethargy. He deteriorated into septic shock and was found to have a hepatic abscess on computer tomography imaging. After multiple investigations and continual deterioration, he underwent an exploratory laparoscopy which revealed a chicken bone within the liver parenchyma resulting in a large hepatic abscess. The patient required a second laparoscopic washout and prolonged antibiotics, subsequently recovering well. This rare case highlights the difficulty in diagnosing hepatic abscesses caused by gastrointestinal foreign bodies, and successful management with laparoscopic surgery.
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Affiliation(s)
- Jai W Hoff
- General Surgery, Rockhampton Hospital, Rockhampton, AUS
| | | | | | - Clay Renwick
- General Surgery, Rockhampton Hospital, Rockhampton, AUS
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16
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Luo CF, Xu J, Lu YQ. Hepatic abscess resulted from a toothpick piercing the gastric wall into the liver. Hepatobiliary Pancreat Dis Int 2020; 19:502-504. [PMID: 32768321 DOI: 10.1016/j.hbpd.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Cui-Fei Luo
- Department of Emergency Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Geriatric Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jia Xu
- Department of Emergency Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Geriatric Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Geriatric Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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17
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Kishawi S, Anderson MJ, Chavin K. Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval. Ann Hepatobiliary Pancreat Surg 2020; 24:362-365. [PMID: 32843606 PMCID: PMC7452798 DOI: 10.14701/ahbps.2020.24.3.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
We present a rare case of a 72-year-old man with recurrent hepatic abscesses secondary to transgastric migration of a toothpick into the liver parenchyma and left portal venous branch. Prior to identification of the foreign body, the patient received multiple courses of antibiotics and underwent image-guided catheter placement without resolution of infection. Given his refractory abdominal pain, fevers, and chills, a repeat abdominal CT was obtained and demonstrated a radio-opaque object extending through the prepyloric gastric submucosa into the liver parenchyma and left portal vein. EGD confirmed a pre-pyloric fistula tract with purulent discharge. The patient subsequently underwent exploratory laparotomy, cholecystectomy, porta hepatis exploration, removal of foreign body, and ligation of porto-enteric fistula tract. A wooden toothpick was removed in its entirety. Interval CT demonstrated resolution of hepatic abscesses and no evidence of persistent porto-enteric fistula. This exceptional case demonstrates the value of multidisciplinary care, hypervigilance for patients with refractory pyogenic liver abscesses of unknown origin, and the importance of careful preoperative planning.
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Affiliation(s)
- Sami Kishawi
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Joseph Anderson
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Chavin
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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18
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Allam M, Pericleous S. Migrated fish bone induced liver abscess: medical management. Pan Afr Med J 2020; 36:140. [PMID: 32849995 PMCID: PMC7422751 DOI: 10.11604/pamj.2020.36.140.23783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/20/2020] [Indexed: 01/24/2023] Open
Abstract
Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ.
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Affiliation(s)
- Moustafa Allam
- Centre of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingdom
| | - Stephanos Pericleous
- Centre of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingdom
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19
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A case of liver abscesses and porto-enteric fistula caused by an ingested toothpick: A review of the distinctive clinical and imaging features. Radiol Case Rep 2020; 15:273-276. [PMID: 31956387 PMCID: PMC6961755 DOI: 10.1016/j.radcr.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/15/2019] [Indexed: 01/29/2023] Open
Abstract
Though foreign body (FB) ingestions are a relatively common occurrence in the bustling emergency department, particularly among children, the vast majority of FBs either pass uneventfully or can be retrieved endoscopically. Only a small percentage of patients will experience complications such as bowel obstruction, ischemia, or perforation that may progress to abscess, septic thrombophlebitis, peritonitis, or shock. Depending on their composition, small FBs can be very difficult to detect on computed tomography (CT). However, a delay in definitive treatment resulting from the failure to clinically or radiologically recognize that a FB may be responsible for the acute presentation can lead to substantial morbidity and mortality. We present a case of unresolving hepatic abscess and recurrent sepsis caused by a toothpick-induced porto-enteric fistula in which the FB was not initially identified, thereby leading to multiple treatment failures and readmissions. This is followed by a literature review with comprehensive discussion of the distinctive clinical and imaging features of migrated FB-induced liver abscesses.
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20
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Morita M, Ogawa C, Omura A, Noda T, Kubo A, Matsunaka T, Tamaki H, Shibatoge M, Seno H, Minami Y, Ueshima K, Sakurai T, Nishida N, Kudo M. The Efficacy of Sonazoid-enhanced Ultrasonography in Decision-making for Liver Abscess Treatment. Intern Med 2020; 59:471-477. [PMID: 32062622 PMCID: PMC7056389 DOI: 10.2169/internalmedicine.2510-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The usefulness of contrast-enhanced ultrasonography (CEUS) for making decisions in the treatment of liver abscess is unknown. Methods We evaluated the internal blood flow in the arterial-predominant phase by CEUS using Sonazoid® in 21 patients. The stain area rate was evaluated in maximum parting plane of abscess in CEUS. Patients were divided into two groups: the vascular phase enhancement (VE) group, in which ≥50% of the abscess cavity was enhanced (12 patients), and the vascular phase non-enhancement (VNE) group, in which <50% of the abscess cavity was enhanced (9 patients). The rate of patients who were cured by conservative treatment alone was examined in both groups. The defect rate of all liver abscesses in the post-vascular phase was also evaluated. Results In the VE group, improvement by conservative treatment alone was obtained in 11 out of 12 patients (91.7%), while in the VNE group, improvement by conservative treatment alone was obtained in only 1 out of 9 patients (11.1%), a significant difference (p<0.001). In the VE group, one patient did not improve with conservative treatment alone because the abscess ruptured near the liver surface. In the VE group, the abscess size was smaller than in the VNE group. By examining the defect rate in the post-vascular phase, it was found that 16 out of 21 patients (76.2%) showed 71% or more defects. Conclusion The enhancement rate in the arterial-predominant phase of CEUS was considered useful for determining the treatment approach for liver abscess.
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Affiliation(s)
- Masahiro Morita
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Akina Omura
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Teruyo Noda
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Atsushi Kubo
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Toshihiro Matsunaka
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Hiroyuki Tamaki
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Mitsushige Shibatoge
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Japan
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
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21
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Venkatesan S, Falhammar H. Pyogenic hepatic abscess secondary to gastric perforation caused by an ingested fish bone. Med J Aust 2019; 211:451-451.e1. [PMID: 31663145 DOI: 10.5694/mja2.50395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Henrik Falhammar
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Darwin, NT.,Karolinska Institutet, Stockholm, Sweden
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22
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Rodrigues AI, Martins Fernandes R, Calderón H, Granja C. Pyogenic liver abscess caused by accidental ingestion of a bottle cap. Intern Emerg Med 2019; 14:1167-1168. [PMID: 31209682 DOI: 10.1007/s11739-019-02125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ana Isabel Rodrigues
- Internal Medicine Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal.
| | - Rita Martins Fernandes
- Internal Medicine Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
| | - Hugo Calderón
- Emergency and Intensive Care Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
| | - Cristina Granja
- Emergency and Intensive Care Department, Centro Hospitalar Universitário Do Algarve, Hospital de Faro, Faro, Portugal
- CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Departamento de Medicina da Comunidade Informação e Decisão em Saúde ‑ MEDCIDS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal
- Department of Biomedical Sciences and Medicine, University of Algarve, Portugal, Faro, Portugal
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23
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Abstract
RATIONALE The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study. PATIENT CONCERNS A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest. DIAGNOSIS AND INTERVENTION Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection. OUTCOMES The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation. LESSONS Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.
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24
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Graça L, Viamonte B, Carvalho C, Sarmento A. Hepatic abscess secondary to gastric perforation. BMJ Case Rep 2019; 12:12/6/e230452. [PMID: 31248890 DOI: 10.1136/bcr-2019-230452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Luísa Graça
- Infectious Diseases, Centro Hospitalar de Sao Joao EPE, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Cláudia Carvalho
- Infectious Diseases, Centro Hospitalar de Sao Joao EPE, Porto, Portugal.,Universidade do Porto Instituto de Saude Publica, Porto, Portugal
| | - António Sarmento
- Infectious Diseases, Centro Hospitalar de Sao Joao EPE, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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25
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Gonçalves RJ, Murinello A, Gomes da Silva S, Coelho JS, Lopes Santos A, Sá Damásio H. Hepatic Abscess due to Streptococcus anginosus and Eikenella corrodens, Secondary to Gastric Perforation by a Fish Bone. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:414-419. [PMID: 31832496 DOI: 10.1159/000497333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Rita João Gonçalves
- Infectious Diseases Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - António Murinello
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sílvia Gomes da Silva
- Hepatobiliary Surgery Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Santos Coelho
- Hepatobiliary Surgery Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Adriana Lopes Santos
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Helena Sá Damásio
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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26
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Chen J, Wang C, Zhuo J, Wen X, Ling Q, Liu Z, Guo H, Xu X, Zheng S. Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e14705. [PMID: 30882633 PMCID: PMC6426515 DOI: 10.1097/md.0000000000014705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Jun Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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27
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Bandeira-de-Mello RG, Bondar G, Schneider E, Wiener-Stensmann IC, Gressler JB, Kruel CRP. Pyogenic Liver Abscess Secondary to Foreign Body (Fish Bone) Treated by Laparoscopy: A Case Report. Ann Hepatol 2018; 17:169-173. [PMID: 29311403 DOI: 10.5604/01.3001.0010.7550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Liver abscess due to perforation of the gastrointestinal tract by a foreign body is a rare and possibly fatal event. Diagnosing this pathology is complicated by the lack of specific symptoms and unfamiliarity of ingestion by the patient and low clinical suspicion of this disease. In the case of liver abscess unresponsive to aspiration and administration of antibiotics, this hypothesis must be made, despite its low incidence. This case report describes and illustrates a case of liver abscess secondary to fish bone ingestion with consequent piercing of the lesser gastric curvature, diagnosed by computed tomography and specific anamnesis. Laparoscopy was performed to extract the foreign body, without complications; the patient is currently asymptomatic and does not present any abnormal physical examination findings. We believe this represents the first case report of a successful laparoscopic treatment in South America for the removal of an ingested foreign body associated with pyogenic liver abscess.
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Affiliation(s)
| | - Gabriel Bondar
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo Schneider
- Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Cleber Rosito Pinto Kruel
- DeparTment of Surgery, Postgraduate Course of Surgery, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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28
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Sivarajah SS, Shahzard S, Chew MH. Unusual Cause of Liver Abscess. Gastroenterology 2018; 155:e7-e8. [PMID: 29885313 DOI: 10.1053/j.gastro.2018.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 12/02/2022]
Affiliation(s)
| | - Sabir Shahzard
- Department of General Surgery, Sengkang Health, Singapore
| | - Min Hoe Chew
- Department of General Surgery, Sengkang Health, Singapore
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29
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Jaén Torrejimeno I, Galeano Díaz F, López Guerra D, Blanco Fernández G. Hepatic abscess caused by a fishbone: An unusual finding. Cir Esp 2018; 97:598-600. [PMID: 29997025 DOI: 10.1016/j.ciresp.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/07/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Isabel Jaén Torrejimeno
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Badajoz, España.
| | - Francisco Galeano Díaz
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Badajoz, España
| | - Diego López Guerra
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Badajoz, España
| | - Gerardo Blanco Fernández
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Badajoz, España
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30
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Hepatic abscess in the Spiegel lobe caused by foreign body penetration: report of a case report. Surg Case Rep 2017; 3:24. [PMID: 28188512 PMCID: PMC5307392 DOI: 10.1186/s40792-017-0297-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/28/2017] [Indexed: 01/02/2023] Open
Abstract
A 69-year-old male patient visited our hospital because of a continuous low-grade fever and right back pain since 2 weeks. Enhanced computed tomography (CT) of his abdomen revealed a mass with ring enhancement (35 × 30 mm) in the Spiegel lobe as well as a needle-like foreign body. Because conservative treatment by fasting and administration of antibiotics was unsuccessful, the patient underwent emergency laparotomy for removal of the foreign body and drainage of the liver abscess. The patient made a satisfactory postoperative recovery without complications and was discharged on the eighth postoperative day. The foreign body was composed of both protein and calcium phosphate and was histologically diagnosed as matured bone. We herein report successful surgical treatment of a patient with a liver abscess in the Spiegel lobe caused by foreign body penetration.
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31
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O'connell PR, Sheehan G. Intra-abdominal Sepsis, Peritonitis, Pancreatitis, Hepatobiliary and Focal Splenic Infection. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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33
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Enterohepatic Migration of Fish Bone Resulting in Liver Abscess. Case Rep Surg 2015; 2015:238342. [PMID: 26634168 PMCID: PMC4655044 DOI: 10.1155/2015/238342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/29/2015] [Indexed: 11/28/2022] Open
Abstract
Liver abscess formation due to enterohepatic migration of a foreign body is extremely rare. Foreign body ingestion is generally an unconscious and painless event, thus complicating preoperative diagnosis in most patients. We report the case of a 61-year-old man who presented with secondary peritonitis from a ruptured hepatic abscess after an ingested fish bone migrated into the liver.
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34
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Esseghaier S, Nassej O, Haouas N, Benhassen I, Maamar AB, Daghfous MH. Un abcès hépatique secondaire à la migration d’un corps étranger ingéré. Presse Med 2015; 44:851-3. [DOI: 10.1016/j.lpm.2015.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/24/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022] Open
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Abstract
A 60-year-old female patient was referred for a massive pyogenic liver abscess that had been initially treated with percutaneous drainage and antibiotics. CT-scan showed a foreign body in the hepatic pedicle, adjacent to the right portal vein: a fishbone. After 6 weeks of medical management with antibiotics, the foreign body was removed laparoscopically. The presence of a foreign body should be sought in cases of pyogenic liver abscess, especially if no other intra-abdominal cause has been found or if the abscess fails to resolve with medical treatment alone.
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Affiliation(s)
- A Dinnoo
- Chirurgie hépato-bilio-pancréatique, Hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy, France
| | - L Barbier
- Chirurgie hépato-bilio-pancréatique, Hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy, France.
| | - O Soubrane
- Chirurgie hépato-bilio-pancréatique, Hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy, France
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36
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Zouros E, Oikonomou D, Theoharis G, Bantias C, Papadimitropoulos K. Perforation of the Cecum by a Toothpick: Report of a Case and Review of the Literature. J Emerg Med 2014; 47:e133-7. [DOI: 10.1016/j.jemermed.2014.06.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 05/28/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022]
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Mühl S, Piso P. [Right-sided upper abdominal pain and postprandial vomiting : The solution lies in details]. Chirurg 2014; 86:696-7. [PMID: 25326275 DOI: 10.1007/s00104-014-2893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Mühl
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland,
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Dangoisse C, Laterre PF. Tracking the foreign body, a rare cause of hepatic abscess. BMC Gastroenterol 2014; 14:167. [PMID: 25262330 PMCID: PMC4190479 DOI: 10.1186/1471-230x-14-167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/16/2014] [Indexed: 02/03/2023] Open
Abstract
Background Foreign body ingestion complicated by perforation of the digestive tract is a well-known occurrence. Contrary to this, perforation by fishbones has most often been described in South East Asian populations, and has the unusual characteristic of often being paucisymptomatic until secondary complications occur. Case presentation We report the case of a 56 year-old man of asian origin who presented with a liver abscess of unknown origin, complicated by septic shock with multiorgan failure. He was later found to have a fishbone impacted in the left lobe of the liver, which had perforated the stomach and gone by unnoticed until presentation. The fishbone was extracted through laparotomy and the abscess was drained. Conclusion This report highlights a cause of liver abscesses which is likely underreported in Northern European populations and which, although rare in occurrence, should be part of our diagnostic algorithm of “cryptogenic abscesses” since surgical removal of the foreign object as drainage warrant definitive treatment.
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Affiliation(s)
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, 1200 Brussels, Belgium.
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Gastric perforation by a foreign body presenting as a pancreatic pseudotumour. Int J Surg Case Rep 2014; 5:437-9. [PMID: 24926924 PMCID: PMC4064400 DOI: 10.1016/j.ijscr.2014.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/20/2014] [Accepted: 04/17/2014] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Foreign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses. PRESENTATION OF CASE Here we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation. DISCUSSION There are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone. CONCLUSION A high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.
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40
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Chong LW, Sun CK, Wu CC, Sun CK. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review. World J Gastroenterol 2014; 20:3703-3711. [PMID: 24707157 PMCID: PMC3974541 DOI: 10.3748/wjg.v20.i13.3703] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
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%.
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Gül M, Aliosmanoğlu İ, Hakseven M, Çetinçakmak MG. Migration of two swallowed foreign bodies to different locations in the same case. ULUSAL CERRAHI DERGISI 2014; 30:228-30. [PMID: 25931922 DOI: 10.5152/ucd.2013.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 11/19/2012] [Indexed: 11/22/2022]
Abstract
Foreign body ingestion can be seen at all ages, especially in childhood. Most swallowed foreign objects are disposed from the body without any health problems through defecation. It is rare that a foreign object perforates the intestine and migrates into the liver or peritoneum. In our case two unintentionally swallowed needles pierced the intestine and were located in the left lobe of the liver and small intestine mesentery. Foreign objects were detected in the abdomen of a 20-year-old female patient during examination performed for abdominal pain that lasted for three months. After a follow up period of three weeks the patient's complaints continued. She underwent laparotomy and both needles were removed in one session. It should be kept in mind that swallowed foreign objects can sometimes perforate the gastrointestinal system and may be located in different organs in the abdomen.
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Affiliation(s)
- Mesut Gül
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - İbrahim Aliosmanoğlu
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Musluh Hakseven
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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Rusman J. A liver abscess presenting as bowel obstruction and perforation. BMJ Case Rep 2013; 2013:bcr-2013-009455. [PMID: 23608874 DOI: 10.1136/bcr-2013-009455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old cachexic man presented with tachycardia and hypotension on a background of 7 days of vomiting and constipation. He was not obviously in pain. He had a raised white cell count of 24.8×10(9)/l, and a lactate of 2.2 mmol/l. A chest x-ray had the appearance of free air under the diaphragm and he was suspected of having a bowel obstruction with perforation. An abdominal CT scan showed instead a large fluid and gas-filled hepatic abscess, and a second smaller simple cyst. The abscess was percutaneously drained, and the purulent fluid drained grew Streptococcus milleri. The patient was discharged home 2 weeks later.
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Affiliation(s)
- Jan Rusman
- Accident and Emergency Department, Chelsea Westminster Hospital, London, UK.
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Mellado JM, Martín J, Solanas S, Yanguas N, Salceda J, Cozcolluela MR. Uncommon causes of acute abdominal pain: multidetector computed tomography pearls and pitfalls for the radiologist on call. Curr Probl Diagn Radiol 2012; 41:179-88. [PMID: 22818838 DOI: 10.1067/j.cpradiol.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We review uncommon causes of acute abdominal pain in which inconclusive multidetector computed tomography (MDCT) studies were followed by emergency surgery and unexpected diagnoses. Despite dedicated protocols and technical advances, MDCT of uncommon causes of acute abdominal pain still represents a significant challenge for the radiologist on call. We emphasize diagnostic pearls and pitfalls that may help the radiologist on call identify or suspect these uncommon causes of acute abdominal pain on MDCT.
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Affiliation(s)
- José María Mellado
- Department of Radiology, Hospital Reina Sofía, Ctra Tarazona, Tudela, Navarra, Spain
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45
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Glick WA, Simo KA, Swan RZ, Sindram D, Iannitti DA, Martinie JB. Pyogenic hepatic abscess secondary to endolumenal perforation of an ingested foreign body. J Gastrointest Surg 2012; 16:885-7. [PMID: 21989581 DOI: 10.1007/s11605-011-1711-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/20/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Pyogenic hepatic abscess induced by foreign body perforation of the gastrointestinal tract is an increasing phenomenon. Pyogenic liver abscess in itself is a challenge to treat without the complication of a foreign body. METHODS A case of a patient who developed a pyogenic hepatic abscess after unknown ingestion of a toothpick that subsequently perforated the duodenum is presented, and a literature review of pyogenic hepatic abscesses secondary to ingestion of foreign bodies and their causes, diagnosis, and treatment was performed. DISCUSSION Even with a thorough workup, often the diagnosis of a pyogenic hepatic abscess secondary to an endolumenal foreign body perforation is not obtained until the time of operation.
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Affiliation(s)
- Wesley A Glick
- Hepato-Pacreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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46
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Klein K, Pegoli W, Lee YH. Transluminal migration of ingested foreign body without peritonitis. J Pediatr Surg 2012; 47:788-91. [PMID: 22498397 DOI: 10.1016/j.jpedsurg.2011.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 10/28/2022]
Abstract
The authors present 2 cases of transluminal migration of an ingested foreign body into the peritoneal cavity without causing peritonitis. Clinical and radiologic features and surgical approach are described, focusing on the absence of an acute abdomen in transluminal migration and the use of laparoscopy in achieving extraction of the foreign object.
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Affiliation(s)
- Kendra Klein
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY 14642, USA
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47
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MacFadden DR, Penner TP, Gold WL. Persistent epigastric pain in an 80-year-old man. CMAJ 2011; 183:925-8. [PMID: 21398231 DOI: 10.1503/cmaj.101510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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48
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Cerwenka H. Pyogenic liver abscess: Differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol 2010; 16:2458-62. [PMID: 20503444 PMCID: PMC2877174 DOI: 10.3748/wjg.v16.i20.2458] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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