Fish bone-induced liver abscess secondary to duodenal perforation: a case report

Gastrointestinal perforation caused by ingested foreign bodies typically presents with acute abdominal symptoms. However, migration of a fish bone through the posterior wall of the duodenum into the liver, resulting in liver abscess formation without abdominal pain, is extremely rare and easily misdiagnosed. This case highlights an atypical clinical presentation and important diagnostic considerations.

A 56-year-old man presented with recurrent fever for 25 days without abdominal pain or gastrointestinal symptoms. Laboratory tests revealed elevated inflammatory markers. Contrast-enhanced computed tomography demonstrated a liver abscess in segment V and a linear hyperdense structure extending from the duodenum into the hepatic parenchyma, suggesting foreign body migration. Emergency laparoscopic exploration was performed, during which a migrated fish bone was removed, the liver abscess was drained, and the duodenal perforation was repaired. The postoperative course was uneventful, with normalization of body temperature on the first postoperative day. The patient was discharged on postoperative day four and showed no recurrence during follow-up.

This case emphasizes that gastrointestinal foreign body perforation and migration should be considered in patients with liver abscess and fever of unknown origin, even in the absence of abdominal pain. Detailed dietary history-taking and careful interpretation of CT imaging are essential for accurate diagnosis, and laparoscopic surgery provides an effective diagnostic and therapeutic approach.