Development of an abdominal wall abscess caused by fish bone ingestion: a case report

Abstract

BackgroundA small percentage of patients with foreign body ingestion develop complications, which have a variety of clinical presentations. Less than 1% of cases require surgical intervention. We present a patient with an abdominal wall abscess resulting from a fish bone that pierced the cecum. The patient was treated laparoscopically.Case presentationA 55-year-old Japanese man presented to our hospital with a complaint of right lower abdominal pain. A physical examination revealed tenderness, swelling, and redness at the right iliac fossa. Computed tomography showed a low-density area with rim enhancement in his right internal oblique muscle and a hyperdense 20 mm-long pointed object in the wall of the adjacent cecum. Based on the findings we suspected an abdominal wall abscess resulting from a migrating ingested fish bone. He was administered antibiotics as conservative treatment, and the abscess was not seen on subsequent computed tomography.Two months after the initial treatment, he presented with the same symptoms, and a computed tomography scan showed the foreign body in the same location as before with the same low-density area. We diagnosed the low-density area as recurrence of the abdominal wall abscess. He underwent laparoscopic surgery to remove the foreign body. His appendix, and part of his cecum and the parietal peritoneum that included the foreign body, were resected. He had an uneventful postoperative course, and at 1 year after the surgery, the abdominal wall abscess had not recurred.ConclusionsAn abdominal wall abscess developed in association with the migration of an ingested fish bone. We suggest that a laparoscopic surgical resection of the portion of the bowel that includes the foreign body is a useful option for selected cases.

Migration of fish bones into abdominal para‐aortic tissue from the duodenum after leading to duodenal perforation: a case report

“…But perforation of a foreign body in the junction of 3rd and 4th part of duodenum is rare. In most cases, the fishbone were in the esophagus, stomach, and 2nd part of duodenum and could be excreted with feces or taken out through the mouth, which may also cause some complications, such as esophageal microperforation with reginal pneumomediastinum, mediastinitis and abscess [ 8 ], ileal perforation [ 9 , 10 ], penetration through the posterior wall of the gastric antrum [ 11 ], cecal perforation [ 12 ], hepatic abscess secondary to gastric perforation [ 13 – 15 ], perforated acalculous cholecystitis [ 16 ], Pylephlebitis and Pyogenic Liver Abscesses [ 17 – 19 ], Small intestinal perforation [ 20 , 21 ], aortic arch pseudoaneurysm [ 22 ], left subclavian artery-esophageal fistula [ 23 ]. But no reports of duodenal perforation have been reported.…”

Fish bone perforation of the small bowel: A case report

“…The management of an ingested foreign body depends on the patient symptoms and the type and the location of the ingested object [ 11 ]. Surgery is the treatment of choice to repair any perforation caused by foreign body, upon development of complications such as abscess, fistula, and ileus.…”

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

“…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].…”