Ruptured Hepatic Abscess Caused by Fish Bone Penetration of the Duodenal Wall: Report of a Case

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.

Tracking the foreign body, a rare cause of hepatic abscess

“…Approximately 80-90% of ingested foreign bodies pass through the gastrointestinal tract unrecognized, generally within one week [ 1 ]. Obstruction or perforation by foreign bodies is thought to occur in less than 1% of cases [ 2 ]. The main risk factor for their ingestion is the use of dentures impairing the sensory feedback of the palate.…”

Laparoscopic retrieval of a sewing needle from the liver: A case report

“…In these cases the abscess can first be drained percutaneously or treated with antibiotics followed by removal of the foreign body [ 2 , 6 , [11] , [12] , [13] ]. One case report describes a ruptured abscess requiring laparotomy with peritoneal lavage [ 14 ]. In symptomatic patients the surgical approach depends on the location of the lesion, the surrounding anatomy, and patient factors.…”

Diagnostic dilemmas due to fish bone ingestion: Case report & literature review

“…Fish bones can also cloud the picture in cases of incarcerated inguinal hernias or umbilical hernias [4,12] . Other rarer complications secondary to fish bone penetration of the bowel include duodenocaval fistula, bladder perforation hepato-enteric fistula & hepatic abscess formation [13–16] . Perforation in the anorectal area can lead to perianal sepsis and Fourniers gangrene [17,18] .…”