Ingestion of fish bones leading to gastric perforation and liver abscess formation: Case study

The presence of foreign materials on or in the liver is uncommon. In general, most ingested foreign bodies pass smoothly through the gastrointestinal (GI) tract. Less than 1% of patients with intestinal perforation have perforation due to foreign bodies. Endoscopy may be helpful if performed before foreign body migration and mucosal healing. US and CT may help in the diagnosis and treatment planning of these unusual foreign bodies. In China, many foreign bodies may cause severe perforation, including toothpicks, fish bones, dates, and chicken bones

Case presentation

A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications.

Thus, the researchers concluded that liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, one must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, one should investigate the general condition, including the whole gastrointestinal tract.

Reference:

Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report by Feng Xia, Peng Zhu et al. published in the BMC Surgery.

https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01457-z