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1
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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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2
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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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3
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Parikh R, Tsakanov S, Jamnagerwalla M. Retroperitoneal abscess caused by foreign body ingestion. ANZ J Surg 2017; 88:E849-E850. [PMID: 28295879 DOI: 10.1111/ans.13930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/06/2016] [Accepted: 01/18/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Roneil Parikh
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Sergei Tsakanov
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Murtaza Jamnagerwalla
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
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4
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Henneman D, Bosman WM, Ritchie ED, van den Bremer J. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis. BMJ Case Rep 2015; 2015:bcr-2014-207806. [PMID: 25739796 DOI: 10.1136/bcr-2014-207806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices.
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Affiliation(s)
- Daniel Henneman
- Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | | | - Ewan D Ritchie
- Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
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5
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Yamaguchi Y, Terashima M, Nakao A, Yoshie N, Fujisaki N, Yamada T, Okamoto A, Hashimoto A, Kotani J. To remove or not remove? Twenty or more sewing needles in the gastrointestinal tract. Acute Med Surg 2014; 1:250-251. [PMID: 29930860 DOI: 10.1002/ams2.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yoshimichi Yamaguchi
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Mariko Terashima
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Atsunori Nakao
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Norichika Yoshie
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Noritomo Fujisaki
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Taihei Yamada
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Ayana Okamoto
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Atsunori Hashimoto
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.,Department of Pediatric Emergency and Critical Care Medicine Hyogo Prefectural Kobe Children's Hospital Kobe Japan
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6
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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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7
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Liang H, Liu OQ, Ai XB, Zhu DQ, Liu JL, Wang A, Gong FY, Hu C. Recurrent upper quadrant pain: a fish bone secondary to gastric perforation and liver abscess. Case Rep Gastroenterol 2011; 5:663-6. [PMID: 22220141 PMCID: PMC3250653 DOI: 10.1159/000335211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT) showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.
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Affiliation(s)
- Hui Liang
- Department of General Surgery, Zhuhai People's Hospital, Zhuhai, China
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8
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Successful endoscopic management of fish bone embedded into the bladder wall. Case Rep Med 2010; 2010:578058. [PMID: 20981260 PMCID: PMC2964009 DOI: 10.1155/2010/578058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 09/27/2010] [Indexed: 11/29/2022] Open
Abstract
We report a case of a pyogenous vesical abscess resulting from an ingested fish bone embedded in the bladder wall that was treated endoscopically in an asymptomatic man. Computed tomography of the abdomen showed a linear radiopaque structure in the thickened left anterolateral wall of the bladder. Cystoscopy revealed a protruding mass, covered with normal-appearing mucosa, with outflow of pus from a shallow recess. Histopathological findings indicated that the transurethrally removed linear structure, located in the submucosa, was compatible with fish bone. A high index of suspicion should be maintained for the correct diagnosis to be made.
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9
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Sethi S, Misra S, Bhandare D, Baylor AE, Dhar R, Ehrinpreis MN. Penetrating Foreign Body Mimicking an Infected Choledochal Cyst: Can Plastic Forks be Dangerous? Am Surg 2010. [DOI: 10.1177/000313481007600710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Saurabh Sethi
- Department of Internal Medicine Wayne State University School of Medicine Detroit, Michigan
| | - Sabeena Misra
- Division of Gastroenterology Wayne State University School of Medicine Detroit, Michigan
| | - Deepti Bhandare
- Department of Internal Medicine Wayne State University School of Medicine Detroit, Michigan
| | - Alfred E. Baylor
- Department of Surgery Wayne State University School of Medicine Detroit, Michigan
| | - Ravi Dhar
- Division of Gastroenterology Wayne State University School of Medicine Detroit, Michigan
| | - Murray N. Ehrinpreis
- Division of Gastroenterology Wayne State University School of Medicine Detroit, Michigan
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10
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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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11
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Affiliation(s)
- Sevil Ariyuca
- Department of Pediatrics, Medicine Faculty, Yuzuncu Yil University, Van, Turkey
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12
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Rosón Rodríguez PJ, López Ortega S, Melgarejo Cordero F, Vázquez Pedreño L, Fernández Castañer A. [Safety of conservative treatment of gastric perforation due to fish bone ingestion]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:552-6. [PMID: 19647345 DOI: 10.1016/j.gastrohep.2009.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 04/23/2009] [Accepted: 05/04/2009] [Indexed: 11/24/2022]
Abstract
Intake of foreign bodies is the second most frequent indication for urgent upper gastrointestinal endoscopy. Once in the stomach, foreign bodies are usually spontaneously eliminated. However, a small percentage of large or sharp objects become stuck in the gastrointestinal mucosa. Fish bones represent a substantial number of ingested foreign bodies. We present two cases of fish bone intake producing gastric perforation satisfactorily resolved with endoscopy. Perforation is considered an absolute spcontraindication for upper and lower gastrointestinal endoscopy. Cases such as those reported herein indicate that the decision to perform endoscopic treatment should always be individualized since punctiform perforations - especially if associated with a parietal and peritoneal inflammatory reaction that helps to close the perforation spontaneously - can be treated non-surgically.
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Affiliation(s)
- Pedro J Rosón Rodríguez
- Servicio de Gastroenterología y Unidad de Endoscopia Digestiva Intervencionista, Hospital Xanit Internacional, Benalmádena, Málaga, España.
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13
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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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14
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Kim JS, Kim HK, Cho YS, Chae HS, Kim CW, Kim BW, Han SW, Choi KY. Extraction and clipping repair of a chicken bone penetrating the gastric wall. World J Gastroenterol 2008; 14:1955-1957. [PMID: 18350641 PMCID: PMC2700413 DOI: 10.3748/wjg.14.1955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 12/10/2007] [Indexed: 02/06/2023] Open
Abstract
We report a case of gastric penetration caused by accidental ingestion of a chicken bone in a 42-year old woman with a partially wearing denture. Three days ago, she accidentally swallowed several lumps of poorly-chewed chicken. Physical examination disclosed mild tenderness in the periumbilical area. Abdominal Computed tomography (CT) showed a suspicious penetration or perforation of the stomach wall measuring about 3 cm, by a linear radiopaque material at the lesser curvature of the antrum. The end of a chicken bone was very close to but did not penetrate the liver. Endoscopic examination revealed a chicken bone that penetrated into the prepyloric antrum. The penetrating chicken bone was removed with grasping forceps. Five endoscopic clips were applied immediately at the removal site and the periumbilical pain resolved promptly. After removal of the chicken bone, the patient was treated with conservative care for three days, after which she was completely asymptomatic and discharged without complication. To treat gastric penetration by a foreign body, endoclipping can be a useful method in patients with no signs or symptoms of peritoneal irritation.
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15
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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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16
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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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17
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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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18
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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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19
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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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20
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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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21
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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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22
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Del Fabbro D, Torzilli G, Gambetti A, Leoni P, Gendarini A, Olivari N. Liver inflammatory pseudotumor due to an intrahepatic wooden toothpick. J Hepatol 2004; 41:498. [PMID: 15336456 DOI: 10.1016/j.jhep.2004.02.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Daniele Del Fabbro
- Hepatobiliary Surgery Unit, 1st Department of Surgery, Hospital of Lodi, Lodi, Italy
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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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Affiliation(s)
- M de la Vega
- Department of Pathology, Hospital Dr Negrín, Las Palmas de Gran Canaria, Spain.
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Sellon DC, Spaulding K, Breuhaus BA, Katz L, Mealey R. Hepatic abscesses in three horses. J Am Vet Med Assoc 2000; 216:882-7, 864-5. [DOI: 10.2460/javma.2000.216.882] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Horii K, Yamazaki O, Matsuyama M, Higaki I, Kawai S, Sakaue Y. Successful treatment of a hepatic abscess that formed secondary to fish bone penetration by percutaneous transhepatic removal of the foreign body: report of a case. Surg Today 1999; 29:922-6. [PMID: 10489138 DOI: 10.1007/bf02482788] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe herein the case of a hepatic abscess that developed secondary to fish bone penetration which was successfully treated without laparotomy. A 61-year-old man was admitted to our hospital with a high fever that had persisted for 2 weeks in spite of medication. Abdominal ultrasonography (AUS) and computed tomography (CT) of the abdomen revealed a hepatic abscess with a linear calcified foreign body and gas. Percutaneous abscess drainage was performed under ultrasonographic guidance. After drainage, the patient became afebrile, and AUS and CT findings demonstrated that the abscess cavity had decreased in size, but still contained the foreign body. Under ultrasonographic guidance and fluoroscopy, we inserted endoscopic forceps into the sinus tract and succeeded in removing the foreign body from the liver. It was found to be a fish bone that was 2.8 cm long and 0.3 cm wide.
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Affiliation(s)
- K Horii
- Department of Surgery, Osaka City General Hospital, Osaka, Japan
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Iafrati MD, Fabry SC, Lee YM, Obrien JW, Schwaitzberg SD. A novel approach to the removal of sharp foreign bodies from the stomach using a combined endoscopic and laparoscopic technique. Gastrointest Endosc 1996; 43:67-70. [PMID: 8903824 DOI: 10.1016/s0016-5107(96)70266-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M D Iafrati
- Departments of Surgery and Gastroenterology, New England Medical Center, Boston, Mass., USA
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