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Huang HY, Wang CC. Migration of a Fish Bone From the Esophagus to the Thyroid Gland. EAR, NOSE & THROAT JOURNAL 2024; 103:765-768. [PMID: 35348022 DOI: 10.1177/01455613221086032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up.
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Affiliation(s)
- Hsiao-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chien-Chung Wang
- Department of Otolaryngology, Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan
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2
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Wu L, Chen XY, Ji D, Zhang ZG, Mao XP. Foreign body-intestinal canal angle guides management of ingested foreign bodies in the lower gastrointestinal tract. Abdom Radiol (NY) 2024; 49:3759-3767. [PMID: 38829394 DOI: 10.1007/s00261-024-04404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Determining whether prompt surgery is required for patient with ingested foreign bodies is clinically important. PURPOSE To evaluate the potential value of computed tomography (CT) in guiding the selection of surgical treatment for patients with ingested foreign bodies in the lower gastrointestinal tract. METHODS Between January 2014 and December 2023, we analyzed the data of 58 patients (median age: 65.4 years; range, 31-96 years) with ingested foreign bodies in the lower gastrointestinal tract who underwent CT examinations. Patients were treated either conservatively (35 cases) or surgically (23 cases). The angle between the long axis of the foreign body and the intestinal canal (FB-IC angle) was measured. CT findings and clinical variables were evaluated to identify potential indicators for surgical treatment through univariate and multivariate logistic regression analyses. RESULTS Univariate analysis revealed the FB-IC angle (P = 0.002), presence of free peritoneal gas (P = 0.002), white blood cell count (P = 0.018), and neutrophil count (P = 0.007) as significant factors associated with surgical treatment. Multivariate analysis demonstrated that the FB-IC angle (odds ratio, 1.033; P = 0.045) and the presence of free peritoneal gas (odds ratio, 41.335; P = 0.002) are independent indicators for surgical management. The FB-IC angle showed an area under the receiver operating characteristic curve of 0.755, with a cutoff value of 51.25 degrees. CONCLUSION The FB-IC angle and presence of free peritoneal gas serve as potential predictive imaging markers for surgical intervention.
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Affiliation(s)
- Lei Wu
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Xiao-Yu Chen
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Dan Ji
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Zhi-Guo Zhang
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Xu-Ping Mao
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China.
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3
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Pham TN, Nguyen QH, Lam HT, Nguyen TD, Vo TD. Foreign Body-Related Liver Abscess: A Case Study on Fishbone. Cureus 2024; 16:e60358. [PMID: 38883136 PMCID: PMC11178145 DOI: 10.7759/cureus.60358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Foreign body-related complications are rare but possibly fatal events in clinical practice. Liver abscess as a result of gastrointestinal perforation caused by foreign bodies is even more rare. We report a case of a 63-year-old man who was admitted with fever and left epigastric pain. Further investigation revealed a liver abscess without resolution despite antibiotic therapy for several weeks. In the second admission, an enhanced computerized tomography scan revealed multiple abscesses in the left lobe of the liver, with a linear radio-dense foreign body within the collection. Open surgery was performed to extract the foreign body. The patient made a satisfactory postoperative recovery without complications and was discharged on the sixth postoperative day.
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Affiliation(s)
- Tram N Pham
- Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Qui H Nguyen
- Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Huong T Lam
- Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thang D Nguyen
- Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, VNM
| | - Thong D Vo
- Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Gastroenterology, University Medical Center of Ho Chi Minh City (HCMC), Ho Chi Minh City, VNM
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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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5
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Sueyoshi K, Otsubo K, Hirota S, Kojima F, Bando T. Fish Bone Descending in the Mediastinum. Ann Thorac Cardiovasc Surg 2023; 29:323-325. [PMID: 35527003 PMCID: PMC10767657 DOI: 10.5761/atcs.cr.22-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Ingested sharp foreign bodies rarely migrate extraluminally into adjacent organs such as the pharynx, lungs, and liver. Herein, we report a case of fish bone ingestion where the foreign body followed a unique migration trajectory. Computed tomography revealed a fish bone extraluminally located in the aortopulmonary space in the left mediastinum and peri-esophageal pneumomediastinum. Endoscopic examination indicated no injury to the esophageal mucosa but showed mucosal lacerations in the left hypopharynx. Accordingly, we reasoned that the fish bone penetrated the laryngopharynx and then descended in the mediastinum.
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Affiliation(s)
- Kuniyo Sueyoshi
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Kosuke Otsubo
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shinya Hirota
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Toru Bando
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
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Minh LHN, Han LTK, Hau NV, Kiet NA, Phong TT, Duong NK, Yen PTH, Vinh NX, Nguyen HQ, Le NQK. Liver abscess caused by the ingested foreign body without sign of gastrointestinal perforation: A case report. Radiol Case Rep 2023; 18:4404-4408. [PMID: 37829164 PMCID: PMC10565680 DOI: 10.1016/j.radcr.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.
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Affiliation(s)
- Le Huu Nhat Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- AIBioMed Research Group, Taipei Medical University, Taipei 110, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110, Taiwan
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Luu Thi Kim Han
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Viet Hau
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Anh Kiet
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Tang Tuan Phong
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Khanh Duong
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Phan Thi Hoang Yen
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Xuan Vinh
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Hien Quang Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410, USA
| | - Nguyen Quoc Khanh Le
- AIBioMed Research Group, Taipei Medical University, Taipei 110, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110, Taiwan
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
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7
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Grayson N, Shanti H, Patel AG. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac026. [PMID: 35178243 PMCID: PMC8846943 DOI: 10.1093/jscr/rjac026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/15/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niamh Grayson
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Hiba Shanti
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Ameet G Patel
- Institute of Liver Studies, Kings College Hospital, London, UK
- Correspondence address. King’s College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: +44-7740-705060;
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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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Macoin E, Kintz P, Gressel A, Leyendecker P, Raul JS, Walch A. The Importance of Autopsy in a Case of Digestive Perforation Undetected by Postmortem Computed Tomography. Am J Forensic Med Pathol 2021; 42:201-204. [PMID: 32956075 DOI: 10.1097/paf.0000000000000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cases of foreign body ingestion in the forensic literature are mainly described in children or psychiatric patients. Postmortem imaging can detect most foreign bodies, but its sensitivity depends, among other things, on the type of item and its location. In some cases, the ingestion of foreign bodies can remain unnoticed and have serious consequences for the patient. We describe the case of a patient who died in a psychiatric seclusion room with no obvious cause and for whom a forensic autopsy was requested. Further investigations showed the existence of a subdural hematoma associated with a midline shift, secondary to a skull fracture that was considered to be the cause of death. Toxicological analyses identified in blood several drugs, including diazepam (24 ng/mL) and its major metabolite nordazepam (24 ng/mL), propranolol (57 ng/mL), paliperidone (9 ng/mL), and loxapine (620 ng/mL). The forensic autopsy revealed the existence of a gastrointestinal perforation after the ingestion of a plastic teaspoon, which the postmortem CT scan had failed to detect. Although technological advances continue to assist the forensic pathologist in his diagnosis, autopsy still has a leading role in forensic investigations and does not yet seem to be replaceable by imaging techniques alone.
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Affiliation(s)
| | - Pascal Kintz
- Toxicology Laboratory at the Institute of Legal Medicine
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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: 0.2] [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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Gheorghiu MI, Bolliet M, David P, Denis B. Case report of abdominal left upper quadrant collection secondary to fish bone perforation. Med Pharm Rep 2020; 93:301-305. [PMID: 32832897 PMCID: PMC7418842 DOI: 10.15386/mpr-1429] [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: 07/24/2019] [Revised: 09/25/2019] [Accepted: 01/22/2020] [Indexed: 11/23/2022] Open
Abstract
We present an unusual case of an intra-abdominal collection which evidenced a rare etiology and raises diagnostic particularities. Background Fish bones ingestion is frequent, but seldom followed by complications. Those are often reported at specific sites. Objectives This case report emphasizes the unusual presentation and site localization of a colonic perforation by a small fish bone, in the context of limited radiological accuracy at the diagnostic phase. Case presentation A 37 year old male was admitted to the gastroenterology ward with upper and left sided abdominal pain associated with fever and marked fatigue. His medical history was marked by a sleeve gastrectomy in 2010 for obesity. Abdominal signs and elevated acute inflammatory syndrome on blood tests were followed by computer tomography which revealed a pericolic mass near the left splenic flexure. The pain and fever increased in intensity, so a laparotomy was proposed. Intraoperatively, a tumor-like lesion was found and a resection with oncologic limits was performed. Microscopic examination of the specimen revealed a fish bone, but only after surgery did the patient confirm that he had eaten fish meal the week before. The post-operative period was uneventful. Conclusion Fish bones remain some of the most frequently ingested alimentary foreign bodies; they may cause atypical clinical presentations, frequently omitted by the patients themselves if symptoms appear delayed. They could also lead to possible high-risk complications which need to be addressed by surgeons.
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Retained Foreign Body Causing a Liver Abscess. Case Rep Emerg Med 2020; 2019:4259646. [PMID: 31934467 PMCID: PMC6942747 DOI: 10.1155/2019/4259646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department. Case Report We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ. Conclusion This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.
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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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14
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Liver abscess caused by fish bone perforation of stomach wall treated by laparoscopic surgery: a case report. Surg Case Rep 2019; 5:79. [PMID: 31093821 PMCID: PMC6520427 DOI: 10.1186/s40792-019-0639-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
Abstract
Background Formation of a liver abscess due to gastrointestinal perforation by a foreign body is rare. In addition, there are few case reports on laparoscopic surgical treatment of a liver abscess caused by perforation of the gastrointestinal tract by a foreign body. Case presentation A 51-year-old man visited our hospital because of fever and anorexia. There were no physical findings except for fever. He had no comorbidities or surgical history. Laboratory tests showed increased inflammatory marker and liver enzyme levels. Abdominal ultrasonography showed a hypoechoic lesion in the left lobe of the liver. Abdominal contrast-enhanced computed tomography revealed an air-containing abscess in the left side of the liver and a high-density linear object. We diagnosed a liver abscess secondary to stomach perforation by a foreign body. Emergency laparoscopic surgery identified a fish bone in the abscess that formed between the stomach and liver. We succeeded in removing the fish bone laparoscopically. The patient was discharged without any postoperative complications on day 11. Conclusions A liver abscess secondary to perforation of the gastrointestinal tract by a foreign body usually requires surgical treatment. Foreign body removal is important to prevent recurrence of liver abscess. In cases with the foreign body located at the liver margin, a laparoscopic approach to the abscess is very useful.
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15
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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: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [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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Gómez Portilla A, Ezurmendia B, Martín E, López de Heredia E, Muriel López J. Fish bone-related intrahepatic abscess. An underdiagnosed condition? Cir Esp 2018; 97:116-118. [PMID: 30031548 DOI: 10.1016/j.ciresp.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Alberto Gómez Portilla
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España.
| | - Bernardo Ezurmendia
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Ernesto Martín
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Eduardo López de Heredia
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Jesús Muriel López
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
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17
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Tan CH, Chang SYH, Cheah YL. Laparoscopic Removal of Intrahepatic Foreign Body: A Novel Technique for Management of an Unusual Cause of Liver Abscess--Fish Bone Migration. J Laparoendosc Adv Surg Tech A 2016; 26:47-50. [PMID: 26779724 DOI: 10.1089/lap.2015.0487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fish bone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. MATERIALS AND METHODS We describe successful laparoscopic removal of intrahepatic fish bones in 2 patients who presented with liver abscesses. Both patients were admitted to our institution with a 2-week history of right upper quadrant pain, fever, chills, and rigors. Radiological imaging revealed the presence of a linear calcified foreign body within a hepatic abscess in the left lateral section of the liver. These findings were suggestive of infection secondary to migration of fish bone from the stomach to the liver. RESULTS Both patients underwent percutaneous drainage of liver abscesses with control of sepsis, followed by laparoscopic removal of intrahepatic fish bones. Localization of the fish bones was facilitated by intraoperative ultrasonographic examination of the liver. Postoperative recovery was fast and uneventful. CONCLUSIONS This is the first report of two consecutive cases of liver abscess caused by fish bone migration where our patients were successfully treated by percutaneous drainage of the abscess followed by laparoscopic removal of intrahepatic fish bone.
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Affiliation(s)
- Chun Hai Tan
- 1 Department of General Surgery, Khoo Teck Puat Hospital , Singapore
| | | | - Yee Lee Cheah
- 3 Consultant, Asian American Liver Centre , Singapore
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18
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Aftab Z, Ali SM, Koliyadan S, Al-Kindi N. Foreign body in the liver: Case report and review of literature. Qatar Med J 2015; 2015:5. [PMID: 26535173 PMCID: PMC4614338 DOI: 10.5339/qmj.2015.5] [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: 12/06/2014] [Accepted: 03/23/2015] [Indexed: 11/04/2022] Open
Abstract
Foreign bodies in the liver, although rare, have been described previously in the literature. While more common in children, adults may also swallow foreign bodies that can reach the liver by penetrating the stomach, duodenum or colon. We describe the case of a young lady who accidentally swallowed a needle, which was later found in the liver by abdominal X-ray and computed tomography (CT). It was removed intact by laparoscopy. A foreign body in the liver is a rare occurrence. Radiology is important in diagnosis through modalities including plain X-ray, ultrasonography and abdominal CT. Removal can be achieved by laparotomy or laparoscopy.
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Affiliation(s)
- Zia Aftab
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Nayil Al-Kindi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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19
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Matrella F, Lhuaire M, Piardi T, Dokmak S, Bruno O, Maestraggi Q, Kianmanesh R, Sommacale D. Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases. Hepatobiliary Surg Nutr 2014; 3:156-62. [PMID: 25019078 DOI: 10.3978/j.issn.2304-3881.2014.04.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/28/2014] [Indexed: 01/16/2023]
Abstract
Several hepatobiliary complications secondary to gastrointestinal perforation after ingestion of a fish bone have been described in the literature, the most common being liver abscess, which can be potentially fatal. Treatment involves removal of the foreign body if possible (endoscopically or surgically), drainage of the abscess (radiologically or surgically), and appropriate antibiotic therapy. To our knowledge, no cases of hepatic hilar abscesses secondary to gastrointestinal perforation by a fish bone have been described in the literature. We report surgical management of two cases of abscess localized in the hepatic hilum secondary to the ingestion of fish bones.
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Affiliation(s)
- Fulvio Matrella
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Martin Lhuaire
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Tullio Piardi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Safi Dokmak
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Onorina Bruno
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Quentin Maestraggi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Daniele Sommacale
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
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20
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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: 41] [Impact Index Per Article: 3.7] [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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21
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Kuo CC, Jen TK, Wen CH, Liu CP, Hsiao HS, Liu YC, Chen KH. Medical treatment for a fish bone-induced ileal micro-perforation: A case report. World J Gastroenterol 2012; 18:5994-8. [PMID: 23139620 PMCID: PMC3491611 DOI: 10.3748/wjg.v18.i41.5994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/23/2012] [Accepted: 07/28/2012] [Indexed: 02/06/2023] Open
Abstract
Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient’s condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient’s good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.
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22
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Yamaguchi N, Suzuki A. Electronic clinical challenges and images in GI. Shivering and right upper quadrant pain. Gastroenterology 2010; 138:e1-2. [PMID: 20347041 DOI: 10.1053/j.gastro.2009.12.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/22/2009] [Accepted: 12/30/2009] [Indexed: 01/27/2023]
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23
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Abstract
A 27-year-old male patient was admitted for renal colic. In the radiographic findings of his kidney-ureter-bladder, a 6-cm-long sewing needle was detected in the right upper abdominal region. The needle displayed a direction toward the diaphragm, and the center of the needle had a radiolucent discontinuity. He refused to be operated. No complication was observed during the 6-year follow-up. Foreign bodies in the liver are generally recommended to be removed. This case is the first one in the literature with a needle in the liver remaining for 6 years without a change of location or causing a complication.
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24
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Leggieri N, Marques-Vidal P, Cerwenka H, Denys A, Dorta G, Moutardier V, Raoult D. Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore) 2010; 89:85-95. [PMID: 20517180 DOI: 10.1097/md.0b013e3181d41c38] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.
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Affiliation(s)
- Nicola Leggieri
- From Service de Maladies Infectieuses et Laboratoire Central de Bactériologie (NL), Hôpitaux Universitaires de Genève, Geneva, Switzerland; Institut Universitaire de Médecine Sociale et Préventive (PMV), Service deRadiologie (AD), Service de Gastroentérologie et d'Hépatologie (GD), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Surgery (HC), Medical University of Graz, Graz, Austria; Service de Chirurgie Viscérale (VM), Hôpital Nord, Marseille, France; and Unité des Rickettsies (DR), Centre Nationale de Recherche Scientifique, Unité Mixte de Recherche, Marseille, France
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25
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Hirasaki S, Inoue A, Kubo M, Oshiro H. Esophageal large fish bone (sea bream jawbone) impaction successfully managed with endoscopy and safely excreted through the intestinal tract. Intern Med 2010; 49:995-9. [PMID: 20519815 DOI: 10.2169/internalmedicine.49.3262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man consulted our hospital because of back pain. A chest computed tomography (CT) demonstrated a high-density foreign body in the esophageal wall. There was no evidence of pneumomediastinum. Endoscopic examination demonstrated a large fish bone that was stuck in the esophageal wall. It was dislodged and moved into the stomach. The bone was excreted through the intestinal tract on the seventh hospital day. Unintentional ingestion of large fish bones must be considered potentially dangerous. Complications such as esophageal perforation or mediastinitis should be confirmed by CT; and then, the esophageal foreign body should be removed as soon as possible.
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Affiliation(s)
- Shoji Hirasaki
- Division of Gastroenterology, Kubo Hospital, Imabari, Japan.
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26
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Dominguez S, Wildhaber BE, Spadola L, Mehrak AD, Chardot C. Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child. J Pediatr Surg 2009; 44:e17-20. [PMID: 19944205 DOI: 10.1016/j.jpedsurg.2009.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. Because of the localization of the needle and subsequent risks of complications, removal was proposed. Laparoscopy showed dense adhesions between liver and duodenum, confirming the migration route. Laparoscopic extraction of an entire sewing needle was performed. Postoperative course was uneventful; the child was discharged home after 2 days and is alive and well 19 months after surgery. Laparoscopy may be useful in children for extraction of intrahepatic foreign bodies, after transduodenal migration.
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Affiliation(s)
- Stéphane Dominguez
- Paediatric Surgery Unit, University Children's Hospital of Geneva, 1211 Geneva, Switzerland
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27
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Affiliation(s)
- Sevil Ariyuca
- Department of Pediatrics, Medicine Faculty, Yuzuncu Yil University, Van, Turkey
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28
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Intra-abdominal needle: Medical malpractice? Forensic Sci Int 2009; 191:e11-3. [DOI: 10.1016/j.forsciint.2009.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 06/16/2009] [Accepted: 07/16/2009] [Indexed: 11/30/2022]
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Abstract
Patients with impacted foreign bodies in the upper aerodigestive tract present commonly to ENT clinics. This case report highlights two important issues in the management of these patients. First, if the evidence of esophageal perforation is strong and contrast swallow is negative, the physician must consider further imaging, such as contrast computed tomography. Second, ENT physicians must beware of the complications of esophageal trauma, including major vascular injury and aortoesophageal fistula, in patients with retained sharp foreign bodies in the mid-esophagus.
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Affiliation(s)
- David Tighe
- Department of Otolaryngology, Birmingham City Hospital, Birmingham, U.K
| | - Andy Wood
- Department of Otolaryngology, Birmingham City Hospital, Birmingham, U.K
| | - Savita Kale
- Department of Otolaryngology, Birmingham City Hospital, Birmingham, U.K
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30
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Ammari I, Longueira Suárez R, Lamas Ferreiro JL, Iribarren Díaz M, Toscano Novella A, Martínez Vázquez C. [Foreign body: an uncommon cause of liver abscess]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:179-180. [PMID: 19233515 DOI: 10.1016/j.gastrohep.2008.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 09/23/2008] [Indexed: 05/27/2023]
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Macchi V, Porzionato A, Bardini R, Parenti A, De Caro R. Rupture of ascending aorta secondary to esophageal perforation by fish bone. J Forensic Sci 2008; 53:1181-4. [PMID: 18643867 DOI: 10.1111/j.1556-4029.2008.00815.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Perforations of both esophagus and aorta after swallowing foreign bodies have been described, with aorto-esophageal fistulas at the level of the descending aorta or aortic arch. We present the case of a 48-year-old man with esophageal perforation by fish bone, mediastinitis, and evidence of perforation of the ascending aorta during surgical drainage of the mediastinum. At autopsy, a fish bone was found under the aortic arch. Serial histological macrosections of the mediastinic block allowed reconstruction of the type of injury suffered and a thorough analysis of mediastinic structures, with preservation of topographic relationships. Direct demonstration of the perforation of the posterior wall of ascending aorta was provided. Histological examination ascribed aortic perforation to migration of the fish bone and direct injury. This is the first anatomical and pathological study of an autopsy case of perforation of the ascending aorta by fish bone.
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Affiliation(s)
- Veronica Macchi
- Department of Human Anatomy and Physiology, University of Padova, Padova, Italy
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32
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Clarençon F, Scatton O, Bruguière E, Silvera S, Afanou G, Soubrane O, Vignaux O, Legmann P. Recurrent liver abscess secondary to ingested fish bone migration: report of a case. Surg Today 2008; 38:572-5. [PMID: 18516543 DOI: 10.1007/s00595-007-3670-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/29/2007] [Indexed: 12/28/2022]
Abstract
Pyogenic liver abscess is an unusual cause of fever and abdominal pain, but it is potentially fatal. It is rarely caused by a local event, but rather by hematogenous dissemination or biliary tract disease. We report an uncommon case of liver abscess caused by the migration of a fish bone through the gastrointestinal wall.
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Affiliation(s)
- Frédéric Clarençon
- Department of Radiology A, Université René Descartes Paris 5, Paris, France
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33
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Gastric perforation by a toothpick causing a liver abscess. Eur Surg 2008. [DOI: 10.1007/s10353-008-0398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kim YM, Lee TH, Jung SH, Kim SM, Im EH, Huh KC, Choi YW, Kang YW. Hepatic abscess that formed secondary to fish bone and had a fistula with the ascending colon. Dig Dis Sci 2007; 52:3515-8. [PMID: 17420945 DOI: 10.1007/s10620-006-9198-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 12/01/2005] [Indexed: 12/11/2022]
Abstract
We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5 x 1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.
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Affiliation(s)
- Yong Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, 685 Gasoowon-dong Seo-gu, Daejeon, Korea
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Karamarkovic AR, Djuranovic SP, Popovic NP, Bumbasirevic VD, Sijacki AD, Blazic IV. Hepatic abscess secondary to a rosemary twig migrating from the stomach into the liver. World J Gastroenterol 2007; 13:5530-5532. [PMID: 17907303 PMCID: PMC4171294 DOI: 10.3748/wjg.v13.i41.5530] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/28/2007] [Accepted: 08/17/2007] [Indexed: 02/06/2023] Open
Abstract
The ingestion of a foreign body that penetrates the gastric wall and migrates to the liver, where it causes an abscess is uncommon. A case of an ingested rosemary twig perforating the gastric antrum, then migrating to the liver, complicated by hepatic abscess and Staphylococcus aureus sepsis is reported. A 59-year-old man without a history of foreign body ingestion was admitted to our hospital because of sepsis and epigastralgia, which had progressively worsened. No foreign body was identified at preoperative imaging, but a rosemary twig was discovered during laparotomy. The liver abscess and sepsis were controlled successfully with surgery and antibiotics. This unusual condition should be kept in mind when dealing with cases of hepatic abscess, or even sepsis of unknown origin. Despite the improvement of non-surgical techniques such as percutaneous drainage and interventional endoscopy, surgery still remains important in the treatment of hepatic abscess caused by an ingested foreign body.
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Affiliation(s)
- Aleksandar-R Karamarkovic
- Center for Emergency Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
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Ruptured hepatic abscess caused by fish bone penetration of the duodenal wall: report of a case. Surg Today 2007; 37:1018-21. [PMID: 17952539 DOI: 10.1007/s00595-007-3524-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/02/2007] [Indexed: 12/14/2022]
Abstract
The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon; however, the development of a hepatic abscess secondary to foreign body perforation is extremely rare. We report the case of a ruptured hepatic abscess caused by fish bone penetration of the duodenal bulb, resulting in generalized peritonitis. A 73-year-old man was admitted to our hospital with generalized abdominal pain and high fever. Computed tomography of the abdomen showed ascites and a heterogeneously enhanced mass with a less-dense center and a linear dense object. We diagnosed a ruptured hepatic abscess caused by a calcified foreign body, which was managed by peritoneal lavage, drainage of the hepatic abscess, and removal of the fish bone, followed by simple closure of the hepatoduodenal fistula. The patient's postoperative course was complicated by systemic inflammatory response syndrome, but he recovered eventually.
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Lanitis S, Filippakis G, Christophides T, Papaconstandinou T, Karaliotas C. Combined laparoscopic and endoscopic approach for the management of two ingested sewing needles: one migrated into the liver and one stuck in the duodenum. J Laparoendosc Adv Surg Tech A 2007; 17:311-4. [PMID: 17570776 DOI: 10.1089/lap.2006.0106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In this paper, we present the case of a 35-year-old Caucasian female, instituted for depression, who swallowed two sewing needles. Despite the fact that the patient on presentation was asymptomatic with a normal clinical examination and blood tests, the workup revealed a contained perforation of the upper gastrointestinal tract (GI) and a migration of one needle to the liver. Moreover, the endoscopy alone failed to remove the other needle, which was stuck in the duodenal wall and, therefore, a combined endoscopic and laparoscopic approach was successfully applied to remove both needles through the abdominal wall. The postoperative recovery was immediate and the patient was discharged after 24 hours. Our aim in this study was, to introduce a combined laparoscopic and endoscopic approach for the removal of any sharp object that gets stuck in the stomach or duodenal wall. Such a technique can be used in difficult cases where endoscopy alone fails to remove sharp objects that get stuck in the alimentary track and where the risk of complications is high. Moreover, we want to discuss the safety and efficacy of the laparoscopic approach in the management of the rare cases of migrated sharp objects from the upper GI tract to the abdominal cavity, provided there is a good preoperative localization. This combined technique has shown excellent results; it is safe and easy to perform and a laparotomy can be avoided. Moreover, the laparoscopic approach is a safe, efficient approach to remove those sharp objects that have migrated into the peritoneal cavity.
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Santos SA, Alberto SCF, Cruz E, Pires E, Figueira T, Coimbra E, Estevez J, Oliveira M, Novais L, Deus JR. Hepatic abscess induced by foreign body: Case report and literature review. World J Gastroenterol 2007; 13:1466-70. [PMID: 17457985 PMCID: PMC4146938 DOI: 10.3748/wjg.v13.i9.1466] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
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Affiliation(s)
- Sofia A Santos
- Department of Gastroenterology, Fernando Fonseca Hospital, Amadora 2720-276, Portugal.
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Yang CY, Kao JH, Liu KL, Chen SJ. Medical treatment of fish bone-related liver abscess. Clin Infect Dis 2006; 41:1689-90. [PMID: 16267752 DOI: 10.1086/498034] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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40
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Lee KF, Chu W, Wong SW, Lai PBS. Hepatic abscess secondary to foreign body perforation of the stomach. Asian J Surg 2005; 28:297-300. [PMID: 16234084 DOI: 10.1016/s1015-9584(09)60365-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Foreign body penetration of the stomach is seldom encountered in general surgical practice. Liver abscess as a consequence of such occurrence has only been reported sporadically. We report three cases of liver abscesses due to direct penetration injury of the stomach by ingested foreign bodies. All three patients presented with clinical features of liver abscess without history of foreign body ingestion. All recovered with surgical treatment. Successful management relies on prompt recognition and early intervention as deaths have been reported due to missed or delayed diagnosis. The potential role of a minimally invasive approach in the management of this entity is also discussed.
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Affiliation(s)
- Kit-Fai Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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41
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Starakis I, Karavias D, Marangos M, Psoni E, Bassaris H. A rooster's revenge: hepatic abscess caused by a chicken bone. Eur J Emerg Med 2005; 12:41-2. [PMID: 15674086 DOI: 10.1097/00063110-200502000-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We present the case of a liver abscess caused by a swallowed chicken bone in an elderly man successfully treated with laparotomy. This report illustrates the difficulties of obtaining a preoperative diagnosis. The prolonged time course of the illness, the lack of history of the ingestion of a foreign body, the relatively non-specific symptoms and signs and the non-specific results obtained by conventional radiography resulted in a delayed recognition of this possibly fatal disease. This rare condition should be kept in mind when dealing with cases of hepatic abscess or even septic shock of unknown origin.
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Affiliation(s)
- Ioannis Starakis
- Department of Internal Medicine, Infectious Diseases Section, University Hospital, 26500 Rion, Patras, Greece.
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42
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Goh BKP, Yong WS, Yeo AWY. Pancreatic and hepatic abscess secondary to fish bone perforation of the duodenum. Dig Dis Sci 2005; 50:1103-1106. [PMID: 15986862 DOI: 10.1007/s10620-005-2712-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Brian K P Goh
- Department of General Surgery, Singapore General Hospital, Singapore 169608.
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Goh BKP, Jeyaraj PR, Chan HS, Ong HS, Agasthian T, Chang KTE, Wong WK. A case of fish bone perforation of the stomach mimicking a locally advanced pancreatic carcinoma. Dig Dis Sci 2004; 49:1935-1937. [PMID: 15628728 DOI: 10.1007/s10620-004-9595-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Brian K P Goh
- Department of General Surgery, Singapore General Hospital, Singapore.
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Nishimoto Y, Suita S, Taguchi T, Noguchi SI, Ieiri S. Hepatic foreign body - a sewing needle - in a child. Asian J Surg 2003; 26:231-3. [PMID: 14530112 DOI: 10.1016/s1015-9584(09)60311-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 1-year-old boy with a needle-like foreign body embedded in the liver. The foreign body was incidentally found in the right hypochondrium on routine chest X-ray during a periodic medical examination. He was asymptomatic and there was neither a history of swallowing a needle nor a puncture wound on his body. The results of blood tests and physical examination were entirely within normal limits. Computed tomography scan showed that the needle was completely buried in the liver. At laparotomy, some fibrous tissue and a scar were recognized between the surface of the left lobe of the liver and the parietal peritoneum of the upper abdominal wall. The end of the sewing needle was manually squeezed out and extracted from the liver. From this operative finding, it was assumed that the needle had penetrated the liver through his skin. His postoperative course was uneventful and he was discharged on postoperative day 8.
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Affiliation(s)
- Yuko Nishimoto
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Chintamani, Singhal V, Lubhana P, Durkhere R, Bhandari S. Liver abscess secondary to a broken needle migration--a case report. BMC Surg 2003; 3:8. [PMID: 14531934 PMCID: PMC239862 DOI: 10.1186/1471-2482-3-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 10/07/2003] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain. CASE REPORT A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery. CONCLUSION It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.
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Affiliation(s)
- Chintamani
- Department of Surgery and Radiology, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi-110023, India.
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Abstract
BACKGROUND Hepatic abscesses often result from a perforation of the gastrointestinal tract. Although rare, this may occur via puncture by a foreign body. The object may directly extend from the stomach or duodenum into the liver, or rarely, the object may perforate the bowel distal to the duodenum and indirectly extend to the liver leading to the formation of an abscess. CASE REPORT A 44-year-old man developed an hepatic abscess. Although the abscess was identified on computed tomography, various imaging studies were unable to identify the cause of the infection. After an extended ICU course, the patient was deemed stable enough to undergo a colonoscopy that demonstrated a foreign body penetrating through the wall of the sigmoid colon. CONCLUSIONS Here we describe the first report of a foreign body leading to a hepatic abscess where the object was identified by colonoscopy. In addition, we present a comprehensive literature review examining the method of identification of gastrointestinal foreign bodies that led to liver abscesses. These findings emphasize that in cases of hepatic abscesses of unknown etiology, direct visualization by colonoscopy may be a useful tool to elucidate the cause of the abscess.
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Affiliation(s)
- Karl Y Bilimoria
- Department of Medicine, Indiana University School of Medicine, University Hospital, 2300, Indianapolis, Indiana 46202, USA.
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Abstract
An 85-year-old woman with Alzheimer's dementia was hospitalized because of prolonged fever, breathlessness, and generalized pain. Blood analysis showed an elevated erythrocyte sedimentation rate, and temporal artery biopsy showed giant cell arteritis. Prednisone therapy was instituted, and the patient's condition partially improved. Incidentally, abdominal radiographs revealed a sewing needle in the right upper quadrant, and computed tomography (CT) showed that the needle was lodged in the liver parenchyma.
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Affiliation(s)
- Bernardino Roca
- Department of Medicine, Hospital General of Castellon, Castellon, Spain.
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48
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Aisa. P. Casos en imagen 4.—Absceso hepático secundario a perforación gástrica por cuerpo extraño. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Theodoropoulou A, Roussomoustakaki M, Michalodimitrakis MN, Kanaki C, Kouroumalis EA. Fatal hepatic abscess caused by a fish bone. Lancet 2002; 359:977. [PMID: 11918943 DOI: 10.1016/s0140-6736(02)07999-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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