• Liver abscess
• case report
• fish bone
• foreign body

• Humans
• Female
• Liver Abscess, Pyogenic/etiology
• Liver Abscess, Pyogenic/diagnostic imaging
• Liver Abscess, Pyogenic/surgery
• Liver Abscess, Pyogenic/diagnosis
• Aged
• Foreign Bodies/complications
• Foreign Bodies/surgery
• Foreign Bodies/diagnostic imaging
• Tomography, X-Ray Computed
• Drainage
• Laparoscopy
• Imaging, Three-Dimensional

• abdominal pain
• balloon enteroscopy
• deep enteroscopy
• fish bone
• foreign body
• gastrointestinal tract bleeding
• hematochezia

• Humans
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Abdominal Pain/etiology
• Foreign Bodies/complications
• Foreign Bodies/surgery
• Ileum/surgery
• Male
• Animals
• Fishes
• Middle Aged
• Female

• Computed tomography
• Foreign body
• Lower gastrointestinal tract

• Humans
• Male
• Female
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Aged
• Middle Aged
• Adult
• Tomography, X-Ray Computed/methods
• Aged, 80 and over
• Retrospective Studies
• Lower Gastrointestinal Tract/diagnostic imaging

• KJXW2023064 Science and Technology Program of Suzhou
• 20239604 Jiangsu Medical Vocational College Campus Collaborative Innovation Research Project

• Chemical hazards
• Food safety
• Human health
• Physical hazards
• Seafood

• Seafood/analysis
• Food Safety
• Humans
• Food Contamination/analysis
• Mediterranean Region
• Animals

• case report
• foreign body
• hepatic
• liver abscess
• portal vein thrombosis
• toothpick

• CT neck
• Foreign body ingestion
• Imaging approach
• Neck
• Neck radiographs
• Radiologists

• Humans
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Neck/diagnostic imaging
• Neck Injuries/diagnostic imaging
• Neck Injuries/surgery

• Fish bone
• Oncologic emergency
• Perforation

Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

• Biliary complications
• Common bile duct
• Endoscopy
• Fish bone
• Foreign body
• Papilla of Vater

• Fish bone
• Indium-111
• Leukocytes
• Perforation
• SPECT/CT
• White blood cells

In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.

• bezoar
• body packing
• dentures
• fish bone
• food bolus
• foreign body

• Animals
• Bone and Bones
• Eating
• Fishes
• Humans
• Seafood
• Singapore

Most patients who ingest fish bones do not develop any complications. The small proportion of patients who do complicate, present with non-specific symptoms. A 64-year-old female patient presented with a 2-month history of abdominal pain. Following clinical evaluation and computed tomography scan of the abdomen, a provisional diagnosis of colon cancer was made. Histology of the resected bowel at hemicolectomy demonstrated a perforation by fish bone with an associated abscess. The case illustrates how fish bone perforation may mislead unsuspecting clinicians and may be misdiagnosed as colonic cancer.

• abscess
• bowel perforation
• colonic malignancy
• computed tomography
• fish bone
• hemicolectomy

• Endoscopic intervention
• Foreign body
• Surgical intervention
• Upper gastrointestinal tract

Fish bone impaction in buccal space abscess is an uncommon dental scenario. A case of young adult with partially edentulous state contributing to this emergency is presented. The history, clinical imaging findings, surgical procedure, and checklist for clinical assessment are briefly described. The point-of-care ultrasonography (POCUS) was used in our case to identify, locate, and perform an ultrasonography-guided removal of impacted fish bone in consolidated abscess of the buccal space. The role of POCUS in cases of dental swellings or uncommon emergencies is emphasized in clinical settings.

• Buccal space abscess
• color Doppler ultrasound
• fish bone impaction
• foreign body
• point-of-care ultrasonography

• Abscess
• Computed tomography
• Fish bone
• Foreign body
• Gastrointestinal perforation

• CT
• Emergency
• Fish bone
• Foreign body
• Gastrointestinal perforation

• Abdomen, Acute/diagnostic imaging
• Abdomen, Acute/etiology
• Animals
• Bone and Bones/diagnostic imaging
• Diagnosis, Differential
• Emergencies
• Fishes
• Foreign Bodies/complications
• Foreign Bodies/diagnostic imaging
• Humans
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestinal Perforation/diagnostic imaging
• Intestinal Perforation/etiology
• Tomography, X-Ray Computed/methods

• Computed tomography
• Diagnosis
• Diagnóstico
• Espina de pescado
• Fishbone
• Gastrointestinal perforation
• Perforación gastrointestinal
• Tomografía computarizada

• Acute appendicitis mimic
• Case report
• Duodenal microperforation
• Fish bone
• Observer error

A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department.

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.

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.

• Eikenella corrodens
• Fish bone
• Liver abscess
• Streptococcus anginosus

• accidents, injuries
• ear, nose and throat/otolaryngology
• head and neck surgery
• otolaryngology / ent
• radiology

• Animals
• Bone and Bones
• Drainage/methods
• Emergency Service, Hospital
• Female
• Foreign-Body Migration/diagnostic imaging
• Foreign-Body Migration/surgery
• Humans
• Middle Aged
• Neck/diagnostic imaging
• Neck Muscles/injuries
• Neck Muscles/surgery
• Pharynx/diagnostic imaging
• Pharynx/surgery
• Postoperative Complications/therapy
• Seafood
• Sharks
• Sri Lanka

Abdominal pain is a common presentation in emergency medicine. We describe the case of a 54-year-old female who presented to the emergency department due to worsening abdominal pain. She had a history of right upper quadrant (RUQ) abdominal pain that had been ongoing for several months. The pain had been thought by the primary care team to be related to gastritis and she had been prescribed a proton pump inhibitor (PPI). Her abdominal pain increased in the three days prior to her presentation to the emergency department (ED). The computed tomography (CT) scan of the abdomen showed a foreign body (FB) in the liver which was successfully removed surgically. Pathology results showed that the FB was consistent with a small bone fragment. Ingestions of FB are common but seldom result in complications. When complications do arise, perforation of a hollow viscous is typically seen. Rarely, transmigration of the FB can occur.

• Acute abdomen
• Bowel perforation
• Fishbone
• Foreign body

• Animals
• Bone and Bones/diagnostic imaging
• Diagnosis, Differential
• Fishes
• Foreign Bodies/diagnostic imaging
• Humans
• Intestinal Perforation/diagnostic imaging
• Intestinal Perforation/etiology

•

Previous description of ectopic thyroid tissue has not included point tenderness as a presenting symptom.

This case presents a painful ectopic thyroid, an unusual presentation, in an atypical location. The patient’s history of an ingested fish bone, her acute presentation, and inconclusive imaging, made this case a diagnostic dilemma.

61-year-old female presented with acutely worsening history of left throat pain and dysphagia after swallowing a fish bone. CT scan showed a foreign body in the anterior wall of the cervical esophagus. EGD studies were inconclusive. Surgical exploration identified and excised a multinodular cystic lesion without connection to esophageal lumen. Pathology described multinodular thyroid parenchyma with chronic inflammation and no evidence of malignancy. No foreign body was located.

Based on the patient’s history, imaging, and acute presentation, an esophageal perforation with abscess formation was the most likely diagnosis. Surgical exploration was the necessary intervention for this patient’s acute symptoms as both a diagnostic and therapeutic tool. The diagnosis of ectopic thyroid tissue from pathology of the excised cystic lesion was unexpected, as the location of tissue and the painful presentation are not typical characteristics of ectopic thyroid tissue. Management of the this case illustrates the dilemma faced in determining the appropriate work up for a patient, without compromising the patient’s safety.

Though painful presentation and this case’s location are rare, ectopic thyroid tissue should be included in the differential diagnosis of point tenderness with an associated lesion on imaging.

• Case report
• Ectopic thyroid tissue
• Exploratory laparotomy
• Painful presentation
• Periesophageal abscess

Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation.

•

Pre-operative diagnosis of fish bone perforation of the bowel is difficult.

The diagnosis of abdominal complications due to fish bone ingestion is particularly difficult as the presentation may mimic common abdominal pathologies.

65 year-old male presented with a two day history of right iliac fossa pain. He denied any nausea and vomiting. He had no systemic systems including fever, change in bowel habit. He had tenderness and guarding localized to the right iliac fossa. He had raised inflammatory markers. A CT scan of the abdomen was performed which showed fat standing in proximity to the terminal ileum, with the appearance of Crohn’s disease. The clinical picture did not match the imaging and so the patient underwent a diagnostic laparoscopy. Findings included an acutely inflamed terminal ileum. A foreign body was identified piercing through at the small bowel wall at the terminal ileum. The foreign body was removed and revealed a fish bone. Intracorporeal sutures were inserted at the site of the microperforation. The patient was discharged well two days post operatively.

Fish bone perforation is not a common cause of gastrointestinal perforation. Unfortunately the history is often non-specific and these people can be misdiagnosed with acute appendicitis & other pathologies. CT scans can be useful to aid diagnostics. It is not however fully sensitive in detecting complications arising from fishbone ingestion.

Management therefore, should be based taking into account primarily the clinical picture & may necessitate diagnostic laparoscopy.

• Aged
• Animals
• Bone and Bones
• Fishes
• Foreign Bodies/complications
• Humans
• Liver Abscess/etiology
• Male

Foreign body ingestion complicated by perforation of the digestive tract is a well-known occurrence. Contrary to this, perforation by fishbones has most often been described in South East Asian populations, and has the unusual characteristic of often being paucisymptomatic until secondary complications occur.

We report the case of a 56 year-old man of asian origin who presented with a liver abscess of unknown origin, complicated by septic shock with multiorgan failure. He was later found to have a fishbone impacted in the left lobe of the liver, which had perforated the stomach and gone by unnoticed until presentation. The fishbone was extracted through laparotomy and the abscess was drained.

This report highlights a cause of liver abscesses which is likely underreported in Northern European populations and which, although rare in occurrence, should be part of our diagnostic algorithm of “cryptogenic abscesses” since surgical removal of the foreign object as drainage warrant definitive treatment.