Hepatic Abscess Induced by Fish Bone Migration: Two Case Reports

Abstract

Dong J. Two giant peritoneal loose bodies were simultaneously found in one patient: a case report and review of the literature. Int J Surg Case Rep. 2017;36:74-7. RESUMOEmbora a ingestão de corpo estranho seja uma situação relativamente comum, a perfuração e penetração do trato gastrointestinal é pouco frequente e a formação de um abcesso hepático é ainda mais rara. Os autores descrevem dois casos de perfuração do trato gastrointestinal por espinha de peixe com formação de abcesso hepático, pertencentes a grupos etários distintos e com diferente apresentação clínica, embora ambos tenham desenvolvido choque séptico. A ausência de história de ingestão de corpo estranho, a inespecificidade dos resultados dos exames complementares e das manifestações clínicas contribuem para um atraso no diagnóstico e, também por isso, influenciam o próprio prognóstico. ABSTRACT Although foreign body ingestion is a common occurrence, perforation and penetration of the gastrointestinal tract is unusual and the development of a hepatic abscess is even more rare. The authors describe two cases of fish bone perforation of the gastrointestinal tract with hepatic perforation and abscess formation, from distinctive age groups and varying presentation, although both developed septic shock. The lack of history of ingestion of foreign bodies, non-specificity of both clinical presentation and complementary examinations all play a role in delaying the diagnosis and therefore in the prognosis itself.

Migration of bamboo toothpick to liver causing paroxysmal pain

“…As segment VI of the liver is close to the colon, we believe that the foreign body may have penetrated the colon wall to reach the liver. When inflammatory malabsorption or adhesions to surrounding tissues occur, they can cause liver abscesses or adhesions to the surrounding peritoneum or organs, which in turn can cause specific symptoms secondary to systemic inflammatory reactions (e.g., anorexia, fever, and vomiting) (10). No bowel perforation was found in the present case.…”

“…Thus, if foreign bodies, especially those made from wood or plastic, are suspected clinically, an ultrasound should be the first choice for the initial comprehensive liver scan (12,13). CT scanning has great diagnostic value because it provides high resolution and high precision imaging (5,10). Unlike in other cases, in the present case, the bamboo toothpick's surface had been painted and was thus clearly visible in the CT scan.…”

“…The results of routine laboratory tests are not specific. If an object is not radiopaque, it cannot be detected (10). Thus, if foreign bodies, especially those made from wood or plastic, are suspected clinically, an ultrasound should be the first choice for the initial comprehensive liver scan (12,13).…”

Migrated fish bone induced liver abscess: medical management

“…Occasionally, FB impaction and perforation can present as an acute upper gastrointestinal bleed[ 3 ]. Contrast enhanced CT scanning is the standard diagnostic modality offering a high resolution and accuracy, followed by abdominal ultrasonography [ 1 , 5 ].…”

“…The most frequently isolated organisms in these abscesses are streptococci [ 1 ]. Isolation of streptococcus milleri on blood cultures is uncommon and should raise the suspicion of an underlying abscess [ 5 ]. Other organisms such as Escherichia coli and Klebsiella pneumonia have also been reported [ 1 ].…”