In this CT image of the patient's abdomen, a foreign body can be seen in the left lobe of the liver. (This is the small white line in the upper left corner of the image. (Image credit: BMJ Case Reports)
Patient: 45-year-old male from Saudi Arabia.
Symptoms: A man went to a medical facility after 10 days of abdominal pain and fever. Doctors performed an ultrasound of the abdomen and found an abscess — a collection of pus — in the right lobe of the liver. They drained the abscess and prescribed a 10-day course of antibiotics. The fever went down, and the patient was sent home.
However, a month later, the man returned to the emergency room, suffering from abdominal pain and a fever above 102.4 degrees Fahrenheit (39.1 degrees Celsius) for six days – an apparent relapse of symptoms.
Next steps: On a return visit to the hospital, blood tests showed the patient had elevated levels of white blood cells, the immune system cells that fight infection, and low levels of albumin, a protein made in the liver. Doctors took an abdominal X-ray but found no abnormalities. A computed tomography (CT) scan showed his kidneys, spleen, pancreas, and gallbladder were normal, doctors wrote in a report on the case.
However, when the medical team examined the central part of the patient's liver, they found two abnormalities. One was a mass resembling an abscess, and the other was a hard, twig-like object about 1 inch (2.5 centimeters) long located inside the mass.
Diagnosis: Doctors suspected that the abscess was caused by an unidentified body, which was likely the cause of the patient's first abscess a month ago.
Treatment: After prescribing antibiotics, doctors performed abdominal surgery, known as a laparotomy, to remove the foreign body, which turned out to be a fish bone.
The patient reported that he probably swallowed it while eating fish about five months ago, although he did not remember feeling anything unusual at the time. After the operation, the man's condition improved. Over the next three months, the hospital monitored his health through follow-up visits, and he had no further abdominal problems.
Uniqueness of the case: Liver abscesses are quite rare. In North America, about two cases per 100,000 people are recorded annually, and in other regions, the numbers can reach up to 17 cases per 100,000 people per year. The main causes of these purulent lesions are infections that occur in the blood, bile ducts, or abdominal organs.
Notably, the patient had a healed scar in an area of the small intestine called the duodenal bulb, indicating that the swallowed fish bone likely penetrated the wall of the man's intestine and then migrated to the liver.
According to a case report, most small fish bones, when swallowed, pass harmlessly through the intestines in about a week.
Disclaimer
This article is for informational purposes only and does not constitute medical advice.
TOPICS Diagnostic Dilemma
Mindy WeisbergerNavigate Social LinksLive Science Contributor
Mindy Weisberger is an editor at Scholastic.
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