Liver abscess due to fish bone ingestion
Rodolfo Mendes Queiroz, Fred Bernardes Filho
The Pan African Medical Journal. 2019;32:26. doi:10.11604/pamj.2019.32.26.17822

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Liver abscess due to fish bone ingestion

Cite this: The Pan African Medical Journal. 2019;32:26. doi:10.11604/pamj.2019.32.26.17822

Received: 03/12/2018 - Accepted: 09/01/2019 - Published: 16/01/2019

Key words: Liver abscess, fish bone ingestion, peptic ulcer

© Rodolfo Mendes Queiroz et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/32/26/full

Corresponding author: Fred Bernardes Filho, Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil (f9filho@gmail.com)


Liver abscess due to fish bone ingestion

Rodolfo Mendes Queiroz1,2, Fred Bernardes Filho3,&

 

1Department of Radiology and Imaging, Santa Casa da Misericórdia of Avaré, Avaré, São Paulo, Brazil, 2Centromed Diagnóstico por Imagem, Avaré, São Paulo, Brazil, 3Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

 

 

&Corresponding author
Fred Bernardes Filho, Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

 

 

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A 50-year-old previously healthy male presented with epigastric pain for 10 days and fever in the last three days. Laboratory testing was remarkable for elevated white blood cells at 19,580/mm3 and C-reactive protein of 83.9 mg/dl. Abdomen computed tomography showed a small linear structure with calcium density, transfixing the wall of the gastric antrum and penetrating the left hepatic lobe; an oval massive hypodensity was observed in the surrounding liver parenchyma (A); pneumoperitoneum, free intra-abdominal fluid or vesicular changes were not observed. The hypothesis of gastric perforation due to ingestion of a foreign body with abscess formation was raised. In a new clinical interview, the patient reported a routine habit of fish consumption. Abdominal surgical approach was performed which confirmed the presence of a fish bone and the hepatic collection with purulent fluid (B). After seven days of surgery and treatment with intravenous ceftriaxone and metronidazole, the patient evolved with clinical and laboratory improvement and was discharged. Gastrointestinal perforation by an ingested fish bone resulting in hepatic abscess is very rare. In these cases, the site of perforation is usually in the stomach or duodenum with the abscess most commonly developing in the left hepatic lobe. The classic indicators of hepatic abscess, such as fever with chills, abdominal pain and jaundice are present in only a small number of patients. Among several causative objects that can perforate the gastrointestinal tract are included toothpicks, sewing needles, hairpins, wire, fish bones, chicken bones and dental plates.

 

 

Figure 1: A) abdomen computed tomography showing a small linear structure with calcium density, transfixing the wall of the gastric antrum and penetrating the left hepatic lobe and an oval massive hypodensity; B) purulent fluid

 

 

 

 

 

 

 

 

 

 

 

 


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Keywords

Liver abscess
Fish bone ingestion
Peptic ulcer

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