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Delay in diagnosis and lessons learnt from a case of abdominal wall abscess caused by fishbone perforation
A Hakeem1, V Shanmugam1, K Badrinath1
1Sherwood Forest Hospitals NHS Foundation Trust , UK.
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.
Insights
Foreign body ingestion, though rare, can cause serious complications. A fishbone was eventually found lodged in a man's abdominal wall after a prolonged inflammatory process, highlighting the need for thorough investigation.
Area of Science:
- Gastroenterology
- Radiology
- General Surgery
Background:
- Foreign body ingestion complications are uncommon.
- A 59-year-old man presented with persistent left iliac fossa pain and bloody stools.
Observation:
- Initial imaging revealed an abdominal wall inflammatory collection. Subsequent investigations were largely unremarkable.
- A repeat CT scan ten months later showed a linear hyperdense structure within the collection, suspected to be a foreign body.
Findings:
- The foreign body, a 3cm fishbone, was identified on retrospective review of all CT scans.
- Surgical incision and removal of the fishbone successfully treated the patient.
Implications:
- This case underscores the importance of considering foreign body ingestion in unexplained intra-abdominal or abdominal wall inflammatory conditions.
- Timely diagnosis and removal of foreign bodies are crucial for effective management and preventing prolonged illness.
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