Woman with abdominal pain and fever.

CASE PRESENTATION

A 79‐year‐old woman with diabetes, hypertension, and chronic kidney disease presented to the emergency department with 2 days of fever, vomiting, diarrhea, and abdominal pain. The patient recently returned from Belize where she was eating seafood. On examination, she had a temperature of 39.4°C, heart rate of 127 beats/min, and right upper quadrant abdominal tenderness. Computed tomography with intravenous contrast was obtained.

DIAGNOSIS

Unintentional foreign body ingestion with pyloric perforation and hepatic abscess.

A 3.1 × 1.6 cm heterogeneous multicystic hepatic lesion was found with a linear hyperdensity (suspected fish bone) extending into the gastric pylorus (Figure 1). The patient underwent exploratory laparoscopy with concurrent endoscopy that found the liver adherent to the stomach wall. The foreign body was palpable but could not be removed. It was thought the perforation had healed behind the foreign body. A percutaneous drain was placed and the patient was treated with intravenous cefepime and metronidazole.

FIGURE 1

Computed tomography (coronal view) demonstrating a linear hyperdense object (white arrow) extending from the gastric pylorus into a heterogenous left hepatic lobe lesion (black arrow)

Unintentionally ingested foreign objects are a common occurrence; 80%–90% pass spontaneously and less than 1% require surgical intervention. Endoscopy is recommended for impacted foreign bodies in the stomach or duodenum, if safely retrievable. Sharp objects, including fish bones, chicken bones, or toothpicks, have increased risk of perforation, with fish bones the most common ingested foreign objects associated with liver abscesses. , Patients are often unaware of the initial ingestion, and nonspecific symptoms may represent an abscess formation. Management of liver abscesses from ingested foreign objects may require a multidisciplinary approach with surgery, percutaneous drainage, and intravenous antibiotics.