Liver abscess and pseudotumoral gastric lesion caused by chicken bone perforation: laparoscopic management. Case Rep Surg. 2012;2012:791857. [PMID: 23198250 PMCID: PMC3502827 DOI: 10.1155/2012/791857]

Spontaneous resolution of gastric perforation caused by an ingested foreign body: a case report

Foreign body ingestions are commonly seen and are usually uneventful. Very rarely, ingested foreign bodies will cause perforation of the gastrointestinal tract, which can lead to peritonitis, abscesses or fistulation. This is the case of a patient with vague abdominal pain after voluntary ingestion of bleach and an ink pen. The ink pen was found lodged in the gastric antral wall on esophagogastroduodenoscopy. The foreign body spontaneously migrated into the gastric lumen and was successfully removed with endoscopy.

Laparoscopy treatment of liver abscess secondary to an unusual foreign body (rosemary twig)

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.

Laparoscopic Management of Hepatic Abscess From Ingested Chicken Bone

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.

Laparoscopic management of complicated foreign body ingestion: a case series

This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients.

Gastric Perforation by Ingested Rabbit Bone Fragment

The majority of accidentally ingested foreign bodies is excreted from the gastrointestinal (GI) tract without any complications. Sometimes sharp foreign bodies – like chicken and fish bones – can lead to intestinal perforation and may present insidiously with a wide range of symptoms and, consequently, different diagnoses. We report the case of a 59-year-old woman presenting with fever and a 1-month history of vague abdominal pain. Computed tomography (CT) showed the presence of a hyperdense linear image close to the gastric antrum surrounded by a fluid collection and free peritoneal air. At laparotomy, a 4-cm rabbit bone fragment covered in inflamed tissue was detected next to a gastric wall perforation. Rabbit bone fragment ingestion, even if rarely reported, should not be underestimated as a possible cause of GI tract perforation.

Unusual liver abscess secondary to ingested foreign body: laparoscopic management

Liver abscess is a cause of febrile abdominal pain and usually the origin of a liver abscess is ascending cholangitis, hemathological diffusion, via the portal vein or the hepatic artery, or superinfection of necrotic tissue. Solitary pyogenic abscess with no obvious systemic cause may be secondary to a local event such as the migration of an ingested foreign body. We report the case of a solitary liver abscess caused by an ingested foreign body, a fish bone, migrated through the gastric wall into the left lobe.

Gastric perforation by a foreign body presenting as a pancreatic pseudotumour

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.

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%.

Gradual colonic impaction of a chicken bone associated with inflammatory pseudotumor formation and nonocclusive colon ischemia

Foreign body (FB) ingestion is a common clinical problem and most FBs pass through the gastrointestinal tract without the need for intervention. A wide spectrum of clinical presentations may be possible and these can be either acute or chronic. We present a case of an 83-year-old woman featuring insidious abdominal discomfort who was hospitalized in our institution due to worsening symptoms. She underwent contrast-enhanced computed tomography (CT) evaluation which showed the presence of a significant parietal thickening of the transverse and descending colon, a mesenteric loose tissue imbibition, venous engorgement, and no filling defect of visceral arteries, suggesting a condition of nonocclusive colon ischemia. A hyperdense FB was identified in the sigma and was associated with a small pseudotumoral mass. The patient underwent surgical exploration which confirmed the hypoperfusional state of the colon, showing the presence of a chicken bone perforating the sigma and lying in the context of a pseudotumoral mass. Our experience shows how contrast-enhanced CT is feasible and can be strongly recommended as a first-line imaging tool on suspicion of colon ischemia and also how it can easily identify the underlying cause, in our case a FB sealed perforation of the sigma with pseudotumoral mass formation.