Uncommon cause of liver abscess.

Gastrointestinal perforation by fishbone causing a liver abscess is a rare entity, but should be included in the differential diagnosis to avoid delay in the treatment.

CASE PRESENTATION

This 35‐year‐old male patient had accidentally swallowed a fishbone 2 months prior to his admittance in the emergency room. At that time, he presented pain in the upper abdomen a few days after ingestion.

He presented abdominal pain and fever. Computed tomography scan showed a liver abscess with a linear calcified body inside (Figures 1, 2, 3). Due to the symptoms, a laparotomy was indicated. Transverse colon was intimately adhered to the liver; after freeing the adhesion, no colic perforation was observed. The abscess was drained and the fishbone removed (Figure 4). Postoperative period was uneventful.

Figure 1

Computed tomography axial image showing a linear calcified body inside the liver abscess

Figure 2

Computed tomography sagital image showing a linear calcified body inside the liver abscess

Figure 3

Tomographic 3D reconstruction showing a linear calcified body in liver topography

Figure 4

Surgical specimen

The diagnosis of a liver abscess caused by fishbone gastrointestinal perforation is difficult, due to its rare nature and also because it is difficult for the patient to remember the accidental ingestion.1 In these cases, complementar imaging exams are fundamental to find a calcified foreign body inside the abscess. Minimally invasive approaches, although not adopted in this particular case, are feasible and described in literature.2

CONFLICT OF INTEREST

None declared.

AUTHORSHIP

ARD: prepared the manuscript, member of surgical team; DJS: prepared the manuscript, member of surgical team; CBAF: reviewed the article; CLN: reviewed the article.