Fish bone-induced pyogenic liver abscess via contained duodenal perforation managed surgically: a case report

Abstract

Pyogenic Liver Abscess (PLA) due to a foreign body (ingestion of fish bone) migration is very rare in occurrence. The diagnosis is usually delayed because the patient has difficulty remembering the history of foreign body ingestion. 44 year old male with immunocompetence presenting with a history of pain in the right upper quadrant, nausea and vomiting for three weeks, had an initial empirical antibiotic course which prevented the classical presentation of fever. His lab tests revealed leucocytosis, neutrophilia, raised inflammatory parameters, as well as abnormal liver enzymes. Contrast-enhanced CT scan showed a linear hyperdense object extending from the first portion of the duodenum to the right hepatic lobe, along with the development of a multiloculated abscess in liver segments VI, VII, and VIII. Laparotomy, fish bone extraction, abscess drainage guided by intra-operative ultrasound with cavity irrigation and drainage were done in the same setting. Culture of pus showed Klebsiella oxytoca, while blood culture came negative. PLA arising from fish bone foreign body reaction should be kept in mind for patients with cryptogenic liver abscess, especially if there is an unusual liver lesion on imaging. Contrast CT scan is the gold standard for diagnosis. Surgical intervention in terms of removal with source control is a good treatment option and gives excellent results. Not applicable.