Delay in diagnosis and lessons learnt from a case of abdominal wall abscess caused by fishbone perforation

Abstract

Complications following foreign body (FB) ingestion are an uncommon clinical problem. A 59-year-old man presented with a 4-week history of left iliac fossa pain and 1 episode of dark red blood mixed with stools. Inflammatory markers were elevated, and computed tomography (CT) of the abdomen and pelvis showed an ill defined abdominal wall inflammatory collection in close contact with the small bowel loops. He was treated with antibiotics, and follow-up CT, colonoscopy and small bowel enema were mostly unremarkable. The patient presented again ten months later with left iliac fossa cellulitis and fever. Multiplanar CT (the patient's fourth scan) demonstrated a 10cm abdominal wall collection with a linear hyperdense structure in the collection. The radiologists suspected a FB and on close scrutiny of the previous scans, they noted it to have been present on all of them. A targeted incision led to the removal of a 3cm fishbone from the collection. This case highlights the need to consider the possibility of a FB being the underlying cause in any unexplained intra-abdominal or abdominal wall inflammatory process so that the diagnosis is made in a timely manner.

Ingested Fishbone Causing Pericolic Abscess

“…It requires a high degree of suspicion as the patient is unable to provide an appropriate history. In a case report by Hakeem et al, there was a 10-month delay in diagnosis of a fish bone perforation of the small bowel with a localized fluid collection 1,2. Only in 1% cases does the foreign body cause complications such as obstruction and perforation.…”

“…In a case report by Hakeem et al, there was a 10-month delay in diagnosis of a fish bone perforation of the small bowel with a localized fluid collection. 1 , 2 Only in 1% cases does the foreign body cause complications such as obstruction and perforation. Dangoisse and Laterre have reported a case of an impacted fish bone in the left lobe of the liver after it perforated the stomach.…”

Teach a man to fillet: gastrointestinal and extra-gastrointestinal complications related to fish bone ingestion

“…13). Due to the gradual migration of fish bone, the perforated bowel is allowed time to seal off without discernible abnormality on CT [15]. Wu et al reported a case of omental abscess resulting from a fish bone that had perforated the terminal ileum; a fibrotic fistula extended from the site of perforation to the abscess, which was surgically resected [16].…”

“…Wu et al reported a case of omental abscess resulting from a fish bone that had perforated the terminal ileum; a fibrotic fistula extended from the site of perforation to the abscess, which was surgically resected [16]. Further superficial migration of the fish bone to form an abdominal wall abscess has been reported, and depending on the depth of involvement, may be treated with incision and drainage or laparoscopic surgery [15,17].…”

Multiple abdominopelvic abscesses caused by fishbone: A case report of rare etiology and literature review

“…The risk of intestinal perforation is low and significantly less to be occurred in the large intestine [ 6 ]. If perforation develops, the patient can present either immediately with acute abdomen or later with intra-abdominal collections [ 7 ].…”