Neglected intrahepatic foreign body following penetrating thoracoabdominal injury: a 10-month delayed presentation

Intrahepatic foreign body (FB) is a rare but clinically important condition that often presents late due to nonspecific symptoms and the absence of a clear history of penetration. We report a 20-year-old woman with a neglected intrahepatic FB after penetrating thoracoabdominal trauma, presenting after a 10-month delay with chest-dominant symptoms. Computed tomography revealed a hyperdense FB with a transcostal trajectory traversing the sixth intercostal space and penetrating hepatic segment III, associated with rib callus formation and a fistulous tract adjacent to the stomach. Exploratory laparotomy excluded gastrointestinal injury, and the FB was removed without complications. This case highlights an uncommon traumatic mechanism and an atypical thoracic presentation that masked underlying hepatic injury. Strict adherence to Advanced Trauma Life Support principles, particularly during the Exposure phase, and timely imaging are essential to prevent diagnostic delays that may lead to serious hepatic complications.