Abdominal Pain and Fever Reveal Migrated Fish Bone
A 72-year-old woman presented with right-sided abdominal pain, nausea, and a fever reaching 38.5 °C, according to a case report. Contrast-enhanced computed tomography subsequently revealed a 4-cm linear foreign body embedded within hepatic segment V.
The patient had no recollection of ingesting a fish bone. Initial laboratory tests showed mild leukocytosis with neutrophilia and a C-reactive protein level of 16 mg/L.
Conservative Management Fails Against Persistent Collections
Doctors initiated treatment with intravenous piperacillin-tazobactam while monitoring the patient closely. Serial computed tomography scans demonstrated that intra-abdominal collections were progressing despite one week of antimicrobial therapy, while percutaneous drainage proved technically unfeasible, the case report stated.
Inflammatory markers had decreased slightly, but repeat computed tomography demonstrated progression of the intra-abdominal inflammatory process, prompting a shift to surgical intervention.
Laparoscopic Extraction Resolves Hepatic Abscess
Surgeons performed a laparoscopy that revealed dense adhesions around the gallbladder and duodenum, though no active duodenal leak was visible. Following careful adhesiolysis, the medical team extracted the 4-cm fish bone from hepatic segment V.
The patient experienced an uneventful recovery and left the hospital on the third postoperative day. Follow-up ultrasonography confirmed the complete resolution of all hepatic collections.
Common Questions About Foreign Body Migration
Why do fish bones migrate to the liver?
Sharp foreign bodies can perforate the stomach or duodenum, which sit directly adjacent to the liver. Local inflammatory adhesions often seal the initial perforation, allowing the object to enter the hepatic parenchyma.
Can doctors diagnose fish bone migration without a known ingestion history?
Yes, cross-sectional imaging frequently identifies these objects even when patients do not recall swallowing them. Computed tomography scans typically reveal a linear hyperdense structure within an atypical hepatic collection.
When is surgery required for an embedded fish bone?
Surgical removal becomes necessary when conservative antibiotic treatment fails to resolve progressive collections and percutaneous drainage is not feasible. The case report said that definitive source control requires extracting the mechanical foreign body.
Related reading