The case of a migratory fish bone.

KEY CLINICAL MESSAGE: We describe a case of a liver abscess due to an ingested foreign body that had migrated through the stomach. Endoscopic removal was performed and laparotomy was avoided.

Case History

A 66-year-old lady presented with acute right upper quadrant pain and tenderness. An ultrasound scan showed a hypoechoic area in the left lobe of the liver, and a triple phase liver CT confirmed a 3 cm liver abscess in segment 3, with a foreign body protruding from the gastric antrum to the abscess (Fig.1). Endoscopy revealed the culprit was a fish bone which had protruded through the antrum of the stomach and into the liver (Fig.2). The fishbone was removed with a biopsy forceps. The patient had a fish and chips meal as a rare treat the week before.

Figure 1

Abdominal CT scan showing foreign body extending from stomach into left liver lobe.

Figure 2

Upper GI endoscopy showing tip of fish bone protruding through the lesser curvature of the stomach.