Large hepatic abscess caused by fish bone

[Liver abscess triggered by a fishbone]

BACKGROUND

Liver abscess caused by foreign bodies constitutes a rare medical problem that few of us will encounter in a clinical setting.

CASE PRESENTATION

We describe a case where a woman presented with sepsis and abdominal pain. Computed tomography (CT) of her abdomen revealed a large hepatic abscess containing a foreign body. Based on the size, shape and density of the object, a fishbone was suspected.

INTERPRETATION

We hypothesise that she swallowed a fishbone, which then perforated the gastrointestinal tract and lodged in the liver. After interdisciplinary discussion it was decided to proceed with conservative management, and the patient was treated successfully with antibiotics for a total of 31 days.

Unusual Pancreatic Abscess Secondary to Embedded Fish Bone: A Challenging Clinical Scenario

The incidental ingestion of fish bone is common, and the ingested fish bone mostly exits the gastrointestinal tract spontaneously. However, severe complications such as perforation in the digestive tract and abscess formation after a period of time may occasionally occur. Fewer than 10 cases of a migrated fish bone penetrating into the pancreas have been reported in the literature, and the development of a subsequent pancreatic abscess is extremely rare. We present one such rare case of pancreatic abscess formation in a middle-aged woman due to fish bone penetration through the gastric wall into the pancreas 2 months after ingestion and missed on endoscopy initially. Further imaging revealed that the fish bone was partially embedded in the pancreatic head surrounded with abscesses and was smoothly removed through laparoscopy.

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

RATIONALE

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

PATIENT CONCERNS

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

DIAGNOSIS

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

INTERVENTIONS

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

OUTCOMES

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

LESSONS

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