Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

Abstract

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient’s upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient’s hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

Epidemiology and Surgical Management of Foreign Bodies in the Liver in the Pediatric Population: A Systematic Review of the Literature

“…Revision of all published data on surgical management of liver FBs confirm that surgical extraction needs to be considered in all patients, mostly based on lessons learned from the adult literature [ 44 ]. Published experiences in adults have reported miscellaneous long-term complications related to retained FBs in the liver: delayed surgery may lead to liver abscess, hepatic granuloma, pseudotumor [ 2 , 6 , 7 , 8 ] or dislocation possibly causing biliary or vascular damage [ 9 , 10 , 11 ].…”

“…Patients are often completely asymptomatic but the persistence of a foreign material inside the parenchyma may cause severe complications, usually infections such as liver abscess, hepatic granuloma, pseudotumor [ 2 , 6 , 7 , 8 ] or dislocate even over the long-term, possibly causing biliary or vascular damage [ 9 , 10 , 11 ].…”

An Unexpected Case of Perforated Acalculous Cholecystitis Caused by a Fish Bone

“…Other complications caused by the migration of a fish bone through the stomach or duodenal wall were described: portal vein thrombosis [9], portal and hepatic abscess associated with portal vein thrombosis [10], liver abscess [11,12], pseudotumoral gastric lesions [13] or liver actinomycosis [14].…”

A Complex Game of Go Fish: A Hybrid Endoscopic and Surgical Approach to a Fish Bone Perforation of the Portal Vein

“…Geographic region also affects the frequencies and types of foreign bodies that are found. 4 Eastern countries, including all the Asian countries, have a different set of intestinal impactions risk; the most common foreign body retrieved are fish bones as Asian countries (and many countries along the Mediterranean) tend to eat fish and meats with the bones intact. A single institution report from Hong Kong found that fish bones are more commonly found in middle-aged women, similar to the patient described in this case.…”

“…A single institution report from Hong Kong found that fish bones are more commonly found in middle-aged women, similar to the patient described in this case. 4 Of the foreign bodies that perforate the digestive tract, 83 per cent occur in the ileocecum. The second most common site of perforation is the recto-sigmoid colon.…”