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Rasmussen IR, Kristensen TS, Penninga L. Fishbone-induced liver abscess. BMJ Case Rep 2025; 18:e264620. [PMID: 40032566 DOI: 10.1136/bcr-2024-264620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025] Open
Affiliation(s)
- Ida Roost Rasmussen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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2
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Li Q, Liu Y. Hepatic abscess caused by foreign body ingestion: A case report. Australas J Ultrasound Med 2025; 28:e12422. [PMID: 39968246 PMCID: PMC11831198 DOI: 10.1002/ajum.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025] Open
Abstract
Introduction Liver abscess is a common clinical condition caused by bacterial, fungal or parasitic infections, usually due to immunosuppression. In contrast, secondary liver abscesses are caused by specific factors such as foreign bodies, tumours, or appendicitis. Methods We admitted a patient with secondary liver abscess and found an intrahepatic foreign body after interventional drainage. Initially, a foreign body of medical origin was suspected, but after a multidisciplinary consultation, it was determined to be caused by a foodborne foreign body. Laparoscopic surgery was then chosen as the treatment. Result The liver abscess was caused by an alimentary foreign body, and the intrahepatic foreign body was identified as a fish bone measuring approximately 2.5 cm in length. Discussion Upon diagnosing either primary or secondary liver abscess, aggressive treatment of the abscess focus is essential. However, in cases of secondary liver abscess, addressing and removing the underlying cause is necessary for complete resolution. For patients with a previously healthy liver, comprehensive history-taking is crucial, and imaging studies play a significant role in diagnosis and treatment. Clinicians and radiologists should be vigilant for the possibility of foreign bodies, tumours, or unexpected intra-abdominal inflammation, regardless of the patient's history. When dealing with food-borne foreign bodies, endoscopic intervention should be considered first, followed by laparoscopy, and as a last resort, open surgery. Conclusion The diagnosis and treatment of liver abscess in clinical practice require a complete medical history and thorough imaging examinations. Ultrasound, as the initial imaging modality, allows real-time and dynamic observation of lesions. It is essential for ultrasonologists to consider the possibility of foreign body-induced liver abscess when diagnosing patients with liver abscess.
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Affiliation(s)
- Qingqing Li
- Department of Ultrasound, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
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3
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Kadi A, Tuergan T, Abulaiti Y, Shalayiadang P, Tayier B, Abulizi A, Tuohuti M, Ahan A. Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report. World J Clin Cases 2022; 10:13402-13407. [PMID: 36683634 PMCID: PMC9850996 DOI: 10.12998/wjcc.v10.i36.13402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/28/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.
CASE SUMMARY This report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient's general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory.
CONCLUSION PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.
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Affiliation(s)
- Abudureyimu Kadi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yierpan Abulaiti
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Paizula Shalayiadang
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Baihetiyaer Tayier
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Abududuaini Abulizi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Muniremu Tuohuti
- Department of General Medicine, First People's Hospital of Aksu Region, Aksu 843099, Xinjiang Uygur Autonomous Region, China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Grayson N, Shanti H, Patel AG. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac026. [PMID: 35178243 PMCID: PMC8846943 DOI: 10.1093/jscr/rjac026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/15/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niamh Grayson
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Hiba Shanti
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Ameet G Patel
- Institute of Liver Studies, Kings College Hospital, London, UK
- Correspondence address. King’s College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: +44-7740-705060;
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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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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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7
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Ma T, Zheng W, An B, Xia Y, Chen G. Small bowel perforation secondary to foreign body ingestion mimicking acute appendicitis: Case report. Medicine (Baltimore) 2019; 98:e16489. [PMID: 31348257 PMCID: PMC6709264 DOI: 10.1097/md.0000000000016489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Foreign body ingestion is often encountered in clinical practice; however, intestinal perforation owing to foreign body ingestion is rare. PATIENT CONCERNS Here, we present the cases of 2 patients who accidentally swallowed foreign bodies and later presented with pain in the right lower abdominal quadrant. DIAGNOSES Both patients were initially diagnosed with acute appendicitis and underwent immediate emergency laparotomy. INTERVENTIONS During the operation, the appendix was found to be only mildly inflamed. On transection of the appendix, the mucosa was found to be inflamed, and yellow-white exudate was noted. We, therefore, decided to explore the entire bowel. The bowel examination revealed small bowel perforations, and palpation of the adjacent bowel revealed a hard, sharp object. The object was removed through the perforation site, the perforation was repaired, and the abdomen was closed in layers. OUTCOME The postoperative recovery, in both cases, was uneventful. LESSONS Patients who swallow sharp or large foreign bodies should undergo endoscopy as soon as possible to avoid intestinal perforation. Clinicians should inquire about a history of foreign body ingestion. The preoperative diagnosis of intestinal perforation secondary to foreign body ingestion requires a high degree of clinical suspicion and awareness.
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Affiliation(s)
- Tantan Ma
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun
| | - Wentao Zheng
- Zhenlai County People's Hospital, Baicheng, Jilin, China
| | - Beiying An
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun
| | - Yan Xia
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun
| | - Geng Chen
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun
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Gonçalves RJ, Murinello A, Gomes da Silva S, Coelho JS, Lopes Santos A, Sá Damásio H. Hepatic Abscess due to Streptococcus anginosus and Eikenella corrodens, Secondary to Gastric Perforation by a Fish Bone. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:414-419. [PMID: 31832496 DOI: 10.1159/000497333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 01/29/2023]
Abstract
Introduction Foreign-body ingestion is a common event, but in only less than 1% of the cases complications occur. Hepatic abscesses induced by foreign-body penetration are rare. To date, there are only 62 reported cases of hepatic abscess secondary to fish bone perforation of the gastrointestinal tract. Case Presentation A 78-year-old male patient was admitted due to high fever and vomiting for 2 days, along with frequent eructations for the past 3 months. Abdominal ultrasound showed a liver abscess in the left lobe, and computed tomography revealed a hyperdense linear image that crossed the superior wall of the gastric antrum, contacting the liver lesion, suggestive of a foreign body, probably a fish bone. Blood cultures were positive with isolation of Streptococcus anginosus and Eikenella corrodens. Ultrasound-guided percutaneous drainage of the abscess was done, and S. anginosus was isolated in the pus. Surgical debridement and fish bone removal were performed; the patient completed 21 days of antibiotic therapy, with a favorable evolution. Conclusion To the best of our knowledge, this is the first reported case of liver abscess caused by fish bone penetration with isolation of S. anginosus and E. corrodens. Bacterial coaggregation is one of the mechanisms that can explain their ability for causing invasive infections away from the oral cavity, by increasing their resistance to the innate immune system and survival of both species.
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Affiliation(s)
- Rita João Gonçalves
- Infectious Diseases Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - António Murinello
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sílvia Gomes da Silva
- Hepatobiliary Surgery Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Santos Coelho
- Hepatobiliary Surgery Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Adriana Lopes Santos
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Helena Sá Damásio
- Internal Medicine Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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9
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Chen J, Wang C, Zhuo J, Wen X, Ling Q, Liu Z, Guo H, Xu X, Zheng S. Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e14705. [PMID: 30882633 PMCID: PMC6426515 DOI: 10.1097/md.0000000000014705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare. PATIENT CONCERNS A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months. DIAGNOSIS A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy. INTERVENTIONS The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length. OUTCOMES The patient recovered uneventfully and was discharged on day 5 after surgery. LESSONS This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.
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Affiliation(s)
- Jun Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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10
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Sarici IS, Topuz O, Sevim Y, Sarigoz T, Ertan T, Karabıyık O, Koc A. Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:72-75. [PMID: 28104902 PMCID: PMC5270761 DOI: 10.12659/ajcr.902004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 18 Final Diagnosis: Perforation Symptoms: Abdominal pain Medication: — Clinical Procedure: Endoscopy Specialty: Surgery
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Affiliation(s)
- Inanc Samil Sarici
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Omer Topuz
- Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Yusuf Sevim
- Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Talha Sarigoz
- Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Tamer Ertan
- Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ozgur Karabıyık
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Koc
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
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11
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Tan CH, Chang SYH, Cheah YL. Laparoscopic Removal of Intrahepatic Foreign Body: A Novel Technique for Management of an Unusual Cause of Liver Abscess--Fish Bone Migration. J Laparoendosc Adv Surg Tech A 2016; 26:47-50. [PMID: 26779724 DOI: 10.1089/lap.2015.0487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fish bone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. MATERIALS AND METHODS We describe successful laparoscopic removal of intrahepatic fish bones in 2 patients who presented with liver abscesses. Both patients were admitted to our institution with a 2-week history of right upper quadrant pain, fever, chills, and rigors. Radiological imaging revealed the presence of a linear calcified foreign body within a hepatic abscess in the left lateral section of the liver. These findings were suggestive of infection secondary to migration of fish bone from the stomach to the liver. RESULTS Both patients underwent percutaneous drainage of liver abscesses with control of sepsis, followed by laparoscopic removal of intrahepatic fish bones. Localization of the fish bones was facilitated by intraoperative ultrasonographic examination of the liver. Postoperative recovery was fast and uneventful. CONCLUSIONS This is the first report of two consecutive cases of liver abscess caused by fish bone migration where our patients were successfully treated by percutaneous drainage of the abscess followed by laparoscopic removal of intrahepatic fish bone.
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Affiliation(s)
- Chun Hai Tan
- 1 Department of General Surgery, Khoo Teck Puat Hospital , Singapore
| | | | - Yee Lee Cheah
- 3 Consultant, Asian American Liver Centre , Singapore
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12
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Yadav AK, Malla G, Deo KB, Giri S, Bhattarai BM, Adhikary S. Jejunal perforation due to ingested buffalo bone mimicking acute appendicitis. BMC Res Notes 2016; 9:321. [PMID: 27342075 PMCID: PMC4919848 DOI: 10.1186/s13104-016-2127-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background Foreign body ingestion is seen quite frequently in clinical practice, intestinal perforation due to this is rare. The foreign body often mimics another cause of acute abdomen and requires an emergency surgical intervention. The majority of patients do not recall ingesting sharp foreign bodies. Case presentation We report an interesting case of a fifty five year-old man who presented with pain in the right iliac fossa with localised tenderness which was clinically diagnosed as acute appendicitis. During the operation, the presence of purulent collection and the inflamed bowel with flakes raised suspicion of bowel perforation. The assessment of the proximal small bowel revealed two small perforations in the jejunum. A hard, bony and sharp object was extracted and the perforations were closed. Post-operative recovery was uneventful. Detailed food history was taken following the recovery of the patient from surgery. It revealed the history ingestion of home prepared buffalo meat. The extracted object was identified as ‘buffalo bone’ by the patient and the care taker of the patient. The jejunum was perforated by the ingested buffalo bone causing local peritonitis in right iliac fossa. Conclusion Intestinal perforation by ingested foreign bodies should be suspected in acute abdomen. It requires a high degree of suspicion and awareness on the part of the clinician. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2127-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ajay Kumar Yadav
- Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Gyanendra Malla
- Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunal Bikram Deo
- Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Saroj Giri
- Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Shailesh Adhikary
- Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Liver Abscess Associated Sepsis Caused by Fish Bone Ingestion. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:322-323. [PMID: 28868489 PMCID: PMC5580013 DOI: 10.1016/j.jpge.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/13/2016] [Indexed: 11/23/2022]
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Xiao L, Li JW, Zheng SG. Laparoscopic Extraction of a Hepatic Fish Bone Mimicking a Liver Mass After Gastric Perforation. Dig Dis Sci 2015; 60:2538-40. [PMID: 25821100 DOI: 10.1007/s10620-015-3637-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/17/2015] [Indexed: 12/09/2022]
Affiliation(s)
- Le Xiao
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China,
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15
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Grassi R, Faggian A, Somma F, De Cecco CN, Laghi A, Caseiro-Alves F. Application of imaging guidelines in patients with foreign body ingestion or inhalation: literature review. Semin Ultrasound CT MR 2014; 36:48-56. [PMID: 25639177 DOI: 10.1053/j.sult.2014.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.
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Affiliation(s)
- Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Francesco Somma
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Carlo Nicola De Cecco
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Filipe Caseiro-Alves
- Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal
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16
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Matrella F, Lhuaire M, Piardi T, Dokmak S, Bruno O, Maestraggi Q, Kianmanesh R, Sommacale D. Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases. Hepatobiliary Surg Nutr 2014; 3:156-62. [PMID: 25019078 DOI: 10.3978/j.issn.2304-3881.2014.04.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/28/2014] [Indexed: 01/16/2023]
Abstract
Several hepatobiliary complications secondary to gastrointestinal perforation after ingestion of a fish bone have been described in the literature, the most common being liver abscess, which can be potentially fatal. Treatment involves removal of the foreign body if possible (endoscopically or surgically), drainage of the abscess (radiologically or surgically), and appropriate antibiotic therapy. To our knowledge, no cases of hepatic hilar abscesses secondary to gastrointestinal perforation by a fish bone have been described in the literature. We report surgical management of two cases of abscess localized in the hepatic hilum secondary to the ingestion of fish bones.
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Affiliation(s)
- Fulvio Matrella
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Martin Lhuaire
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Tullio Piardi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Safi Dokmak
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Onorina Bruno
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Quentin Maestraggi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Daniele Sommacale
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
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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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18
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Jurado García J, Ruiz Cuesta P, Hervás Molina AJ, Rodríguez Perálvarez ML, García Sánchez V. [Endoscopic extraction of a foreign body in the sigmoid colon]. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:647-648. [PMID: 23856088 DOI: 10.1016/j.gastrohep.2013.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Juan Jurado García
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
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19
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Abu-Wasel B, Eltawil KM, Keough V, Molinari M. Liver abscess caused by toothpick and treated by laparoscopic left hepatic resection: case report and literature review. BMJ Case Rep 2012; 2012:bcr-2012-006408. [PMID: 22969156 DOI: 10.1136/bcr-2012-006408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hepatic abscesses caused by ingested foreign bodies have been reported in the medical literature but represent very uncommon events. Extra-luminal migration of sawing needles and pins is the most common cause of perforation of the gastrointestinal tract associated with liver infections. Other non-metallic sharp objects such as animal bones and toothpicks have been described but are less frequent. The authors present a case of a 45-year-old woman who suffered from sepsis and a liver abscess because of the migration of a toothpick that lodged in the left hepatic lobe. Review of the literature on the pathogenesis and clinical management of liver abscesses caused by ingested foreign is presented.
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Affiliation(s)
- Bassam Abu-Wasel
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Masoodi I, Alsayari K, Al Mohaimeed K, Ahmad S, Almtawa A, Alomair A, Alqutub A, Khan S. Fish bone migration: an unusual cause of liver abscess. BMJ Case Rep 2012; 2012:bcr.09.2011.4838. [PMID: 22605588 DOI: 10.1136/bcr.09.2011.4838] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Treating a pyogenic liver abscess is a therapeutic challenge when a patient presents with atypical symptoms. One of the rare causes of treatment failure of these abscesses is the unrecognised migration of a foreign body from the gastrointestinal tract. The authors describe a pyogenic liver abscess in a 45-year-old male who presented with a 10 day history of fever, and abdominal pain. A CT scan of the abdomen revealed a needle-like foreign body in the liver. At operation a 2.5 cm fish bone was extracted from the liver. Subsequently, his feverish symptoms disappeared, and he has remained well in the ensuing 3 month postoperative period. Fish bone-induced liver abscess is discussed in this brief report.
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Affiliation(s)
- Ibrahim Masoodi
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia.
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21
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Jarry J, Nguyen V, Stoltz A, Imperato M, Michel P. A fish bone-related hepatic abscess. Clin Pract 2011; 1:e115. [PMID: 24765356 PMCID: PMC3981416 DOI: 10.4081/cp.2011.e115] [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] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/19/2011] [Accepted: 11/03/2011] [Indexed: 11/23/2022] Open
Abstract
We report an unusual case of pyogenic, hepatic abscess caused by fish bone penetration of the duodenum in a 68-year-old woman. The fish bone had migrated into the liver through the duodenal wall. The patient was initially admitted to our emergency room with abdominal pain, fever, and asthenia. A contrastenhanced abdominal coputed tomography (CT) scan showed a hepatic abscess in relation with a straight, foreign body, which had entered through the duodenal wall. Surgery was necessary to remove the foreign body, which was identified as a fish bone. The patient's recovery was uneventful and she was discharged on postoperative day 10. This case is discussed together with the data collected by a medline-based extensive review of the literature.
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Affiliation(s)
- Julien Jarry
- Department of Digestive Surgery, Desgenettes Hospital, Lyon, France
| | - Vien Nguyen
- Department of Digestive Surgery, Desgenettes Hospital, Lyon, France
| | - Adeline Stoltz
- Department of Digestive Surgery, Desgenettes Hospital, Lyon, France
| | - Marc Imperato
- Department of Digestive Surgery, Desgenettes Hospital, Lyon, France
| | - Philippe Michel
- Department of Digestive Surgery, Desgenettes Hospital, Lyon, France
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22
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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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23
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Hirasaki S, Inoue A, Kubo M, Oshiro H. Esophageal large fish bone (sea bream jawbone) impaction successfully managed with endoscopy and safely excreted through the intestinal tract. Intern Med 2010; 49:995-9. [PMID: 20519815 DOI: 10.2169/internalmedicine.49.3262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man consulted our hospital because of back pain. A chest computed tomography (CT) demonstrated a high-density foreign body in the esophageal wall. There was no evidence of pneumomediastinum. Endoscopic examination demonstrated a large fish bone that was stuck in the esophageal wall. It was dislodged and moved into the stomach. The bone was excreted through the intestinal tract on the seventh hospital day. Unintentional ingestion of large fish bones must be considered potentially dangerous. Complications such as esophageal perforation or mediastinitis should be confirmed by CT; and then, the esophageal foreign body should be removed as soon as possible.
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Affiliation(s)
- Shoji Hirasaki
- Division of Gastroenterology, Kubo Hospital, Imabari, Japan.
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24
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Hepatobiliary and splenic infection. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Dominguez S, Wildhaber BE, Spadola L, Mehrak AD, Chardot C. Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child. J Pediatr Surg 2009; 44:e17-20. [PMID: 19944205 DOI: 10.1016/j.jpedsurg.2009.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. Because of the localization of the needle and subsequent risks of complications, removal was proposed. Laparoscopy showed dense adhesions between liver and duodenum, confirming the migration route. Laparoscopic extraction of an entire sewing needle was performed. Postoperative course was uneventful; the child was discharged home after 2 days and is alive and well 19 months after surgery. Laparoscopy may be useful in children for extraction of intrahepatic foreign bodies, after transduodenal migration.
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Affiliation(s)
- Stéphane Dominguez
- Paediatric Surgery Unit, University Children's Hospital of Geneva, 1211 Geneva, Switzerland
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26
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Tsalis K, Blouhos K, Kapetanos D, Kontakiotis T, Lazaridis C. Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report. CASES JOURNAL 2009; 2:164. [PMID: 19946475 PMCID: PMC2783120 DOI: 10.1186/1757-1626-2-164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 10/22/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. CASE REPORT A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. CONCLUSION The patient was successfully treated using conservative measures.
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Affiliation(s)
- Konstantinos Tsalis
- 4th Surgical Department, Aristotle University of Thessaloniki, George Papanikolaou Str, Thessaloniki, 57010, Greece.
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27
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Akbulut S, Cakabay B, Sezgin A, Ozhasenekler A, Senol A. Careless use of turban pins: a possible problem for turbaned patients. J Gastrointest Surg 2009; 13:1859-63. [PMID: 19655205 DOI: 10.1007/s11605-009-0985-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 07/24/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Foreign body ingestion is rare in adults. In recent years, however, ingestion of the pins that are used for securing turbans has frequently been observed among young Islamic women. This article reviews the patients who were admitted to our emergency unit for turban pin ingestion. METHODS Between 2005 and 2009, 42 patients were admitted to our emergency unit with problems involving turban pins. The patients' characteristics were analyzed, including age; marital status; career; type, number, and location of pins; and history of gastrointestinal surgery. RESULTS The patients ranged in age between 11 and 48 years. Of the patients, 22 were single, and 20 were married; 19 were students, and 23 were housewives. The patients visited the emergency unit within 1 to 12 h after they had ingested the pins. Eight of the patients had ingested two pins each, while the others had ingested one pin each. The pins ingested most frequently were those with ball heads. Spontaneous excretion took 3 to 16 days. Of the patients who did not pass the pins spontaneously with feces, the pins were extracted at endoscopy in three and at laparotomy in one. The patients were followed up for 4 to 49 months. No pathological problems were noted during follow-up. CONCLUSIONS Turban pin ingestion is common in Islamic populations, and the treatment requires a systemic approach and careful follow-up. Pin ingestion can be prevented by increasing public awareness and avoiding holding pins in the mouth when fixing a turban or wearing a type of turban that does not require pins.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400, Dagkapi, Diyarbakir, Turkey.
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28
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Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report review of the literature. CASES JOURNAL 2009; 2:6784. [PMID: 19918542 PMCID: PMC2769312 DOI: 10.4076/1757-1626-2-6784] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 08/19/2009] [Indexed: 11/08/2022]
Abstract
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. The patient was successfully treated using conservative measures.
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29
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Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report. J Med Case Rep 2009; 3:7385. [PMID: 19830197 PMCID: PMC2737780 DOI: 10.4076/1752-1947-3-7385] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 01/24/2009] [Indexed: 12/21/2022] Open
Abstract
Introduction Gastrointestinal perforation due to a foreign body is not unknown. The foreign body often mimics another cause of acute abdomen and requires emergency surgical intervention. The majority of patients do not recall ingesting the foreign body. Perforations have been reported to occur in a pathologically abnormal colon. Case presentation We report an interesting case of a 47-year-old Caucasian man who had a perforation of the sigmoid colon caused by an ingested chicken bone mimicking acute appendicitis. Our patient presented with right iliac fossa pain and local tenderness. When a laparotomy was performed, a chicken bone was found protruding through the sigmoid colon, which was found to lie in the right iliac fossa, thus mimicking acute appendicitis. Our case is different from previously reported cases in that perforation occurred in a non-pathological colon. Conclusion Our case emphasises the fact that the operating surgeon has to be aware of various differential diagnostic possibilities which mimic acute appendicitis. This has implications on the training of junior surgeons who are often involved in performing these procedures, and may do so out of hours. Care needs to be taken while obtaining consent for the necessary operation.
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Macchi V, Porzionato A, Bardini R, Parenti A, De Caro R. Rupture of ascending aorta secondary to esophageal perforation by fish bone. J Forensic Sci 2008; 53:1181-4. [PMID: 18643867 DOI: 10.1111/j.1556-4029.2008.00815.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Perforations of both esophagus and aorta after swallowing foreign bodies have been described, with aorto-esophageal fistulas at the level of the descending aorta or aortic arch. We present the case of a 48-year-old man with esophageal perforation by fish bone, mediastinitis, and evidence of perforation of the ascending aorta during surgical drainage of the mediastinum. At autopsy, a fish bone was found under the aortic arch. Serial histological macrosections of the mediastinic block allowed reconstruction of the type of injury suffered and a thorough analysis of mediastinic structures, with preservation of topographic relationships. Direct demonstration of the perforation of the posterior wall of ascending aorta was provided. Histological examination ascribed aortic perforation to migration of the fish bone and direct injury. This is the first anatomical and pathological study of an autopsy case of perforation of the ascending aorta by fish bone.
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Affiliation(s)
- Veronica Macchi
- Department of Human Anatomy and Physiology, University of Padova, Padova, Italy
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31
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Clarençon F, Scatton O, Bruguière E, Silvera S, Afanou G, Soubrane O, Vignaux O, Legmann P. Recurrent liver abscess secondary to ingested fish bone migration: report of a case. Surg Today 2008; 38:572-5. [PMID: 18516543 DOI: 10.1007/s00595-007-3670-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/29/2007] [Indexed: 12/28/2022]
Abstract
Pyogenic liver abscess is an unusual cause of fever and abdominal pain, but it is potentially fatal. It is rarely caused by a local event, but rather by hematogenous dissemination or biliary tract disease. We report an uncommon case of liver abscess caused by the migration of a fish bone through the gastrointestinal wall.
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Affiliation(s)
- Frédéric Clarençon
- Department of Radiology A, Université René Descartes Paris 5, Paris, France
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32
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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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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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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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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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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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Starakis I, Karavias D, Marangos M, Psoni E, Bassaris H. A rooster's revenge: hepatic abscess caused by a chicken bone. Eur J Emerg Med 2005; 12:41-2. [PMID: 15674086 DOI: 10.1097/00063110-200502000-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We present the case of a liver abscess caused by a swallowed chicken bone in an elderly man successfully treated with laparotomy. This report illustrates the difficulties of obtaining a preoperative diagnosis. The prolonged time course of the illness, the lack of history of the ingestion of a foreign body, the relatively non-specific symptoms and signs and the non-specific results obtained by conventional radiography resulted in a delayed recognition of this possibly fatal disease. This rare condition should be kept in mind when dealing with cases of hepatic abscess or even septic shock of unknown origin.
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Affiliation(s)
- Ioannis Starakis
- Department of Internal Medicine, Infectious Diseases Section, University Hospital, 26500 Rion, Patras, Greece.
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Goh BKP, Yong WS, Yeo AWY. Pancreatic and hepatic abscess secondary to fish bone perforation of the duodenum. Dig Dis Sci 2005; 50:1103-1106. [PMID: 15986862 DOI: 10.1007/s10620-005-2712-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Brian K P Goh
- Department of General Surgery, Singapore General Hospital, Singapore 169608.
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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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40
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Torzilli G, Olivari N, Del Fabbro D, Leoni P, Gendarini A, Palmisano A, Montorsi M, Makuuchi M. Indication and contraindication for hepatic resection for liver tumors without fine-needle biopsy: validation and extension of an Eastern approach in a Western community hospital. Liver Transpl 2004; 10:S30-3. [PMID: 14762836 DOI: 10.1002/lt.20051] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are not negligible. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, not just to address but also to rule out from a surgical program patients with focal liver lesions (FLLs). From September 2001 to July 2003, 89 patients were seen at an outpatient clinic for FLLs. Nine patients were excluded because of previous FNB and 18 were excluded because carrier of advanced disease. Sixty-two patients with 101 FLLs were included. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography (US), and spiral computed tomography (CT). Other imaging modalities were carried out when it was considered necessary. Forty-eight patients underwent surgery, with histological confirmation of the preoperative diagnosis. The remaining 14 patients underwent a close follow-up. The preoperative diagnoses of 47 of the 48 patients who underwent surgery were confirmed (97.9%). All of the 14 patients ruled out for surgical treatment did not show FLL progression at 6-24 months of follow-up. Of the 9 patients who had FNB previously in other centers, 2 had a wrong histological diagnosis. In view of these results, a diagnostic work-up without FNB seems adequate either to include or to exclude patients with potentially resectable FLL from the surgical program and once more highlight the fact that the use of FNB should be drastically limited.
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Affiliation(s)
- Guido Torzilli
- Hepatobiliary Surgery Unit, 1st Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy.
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Chintamani, Singhal V, Lubhana P, Durkhere R, Bhandari S. Liver abscess secondary to a broken needle migration--a case report. BMC Surg 2003; 3:8. [PMID: 14531934 PMCID: PMC239862 DOI: 10.1186/1471-2482-3-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 10/07/2003] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain. CASE REPORT A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery. CONCLUSION It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.
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Affiliation(s)
- Chintamani
- Department of Surgery and Radiology, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi-110023, India.
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