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Liver abscess caused by fish bone perforation of Meckel's diverticulum: a case report
Seiji Natsuki1, Yasuhito Iseki2, Hishashi Nagahara1
1Department of Gastroenterological surgery, Osaka City University Graduate School of Medicine, 1-5-7 asahimachi, abeno-ku, osaka-shi, Osaka-fu, 545-8586, Japan.
Background:
Liver abscess due to gastrointestinal perforation by foreign bodies is rare. Furthermore, there are few case reports of liver abscess via the portal vein caused by perforation of the lower gastrointestinal tract by a foreign body.
Case Presentation:
A 54-year-old man visited our hospital because of a fever that had lasted for 1 month. There were no physical findings except for the fever. Laboratory tests showed only elevated inflammatory markers. Abdominal contrast-enhanced computed tomography revealed an abscess in the right lobe of the liver and a high-density object in the small intestine. We diagnosed him with liver abscess secondary to intestinal perforation by a foreign body. The patient underwent drainage of the liver abscess and laparoscopic surgery for perforation of the small intestine. A fish bone had perforated the top of Meckel's diverticulum, which had been covered by the ileal mesentery. We successfully performed diverticulectomy and removed the fish bone. The patient was discharged without complications on the 13th postoperative day.
Conclusions:
Liver abscess caused by foreign bodies requires multidisciplinary treatment, so we must detect and remove the cause of the abscess earlier. Liver abscess can form via the portal vein secondary to lower gastrointestinal perforation, as in this case. When exploring the cause of liver abscess, we should investigate the whole body, including the lower gastrointestinal tract.
Insights
A rare case of liver abscess caused by a fish bone perforating the small intestine highlights the need for early detection and multidisciplinary treatment. Prompt diagnosis and removal of foreign bodies are crucial for managing such gastrointestinal complications.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Disease
Background:
- Liver abscess secondary to gastrointestinal perforation by foreign bodies is uncommon.
- Portal vein seeding of infection from lower gastrointestinal tract perforation is rarely reported.
Observation:
- A 54-year-old male presented with a month-long fever and elevated inflammatory markers.
- Computed tomography revealed a liver abscess and a foreign body in the small intestine.
- A fish bone was found to have perforated Meckel's diverticulum.
Findings:
- The patient underwent successful liver abscess drainage and laparoscopic surgery for small intestine perforation.
- Diverticulectomy and foreign body removal were performed.
- The patient recovered without complications.
Implications:
- Early detection and removal of foreign body causes are essential for managing liver abscesses.
- Lower gastrointestinal perforation can lead to liver abscesses via the portal vein.
- Comprehensive investigation, including the lower gastrointestinal tract, is vital when diagnosing liver abscesses.
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