Danish doctors treated a man whose swallowed fish bone had penetrated his liver and caused an abscess. In this rare case, antibiotic therapy was sufficient, without surgical intervention. The case report was published in BMJ Case Reports.
Typical causes of liver abscesses (suppuration with cavity formation) include complications of cholangitis, penetration of purulent infection via blood or surrounding tissue, and trauma. Foreign objects are uncommon as an etiologic factor, and fish bones are extremely rare. Typically, laparoscopy or liver removal are used to treat such abscesses; in rare cases, antibiotic treatment alone is effective. Patients are usually cured, but fish bone penetration can lead to severe sepsis and death.
A man in his 60s was admitted to Luit Penninga and his colleagues at Copenhagen University Hospital with a 10-day history of intermittent fever. He had no other symptoms except for a red spot on his neck. Doctors suspected erysipelas (a streptococcal skin infection) and prescribed appropriate antibiotics. The fever continued to rise cyclically for the next six days, and laboratory tests indicated active inflammation—the treatment was ineffective.
To determine the source of the infection, the man underwent a CT scan of his internal organs, which revealed an eight-centimeter abscess in the left lobe of the liver containing a radiographically dense object. The antibiotic regimen was changed to intravenous piperacillin with tazobactam and metronidazole (this combination has a broad spectrum of activity against pathogens that cause abdominal infections). An attempt to drain the abscess under ultrasound guidance was also made, but this was unsuccessful.
Antibiotic therapy was continued for four weeks, with no further symptoms observed. Three months later, the patient underwent a repeat CT scan. It revealed the abscess had resolved; the foreign object in the left lobe of the liver remained in place. Based on its shape and density, doctors concluded it was a swallowed fishbone. Adhesion of the stomach wall to the liver in the area of the abscess, likely caused by the bone penetration, also supported the diagnosis. Since the man was asymptomatic, specialists decided not to remove the foreign object to avoid further damage to the liver and other organs.
Previously, Chinese doctors shared the case of a 70-year-old patient whose bile ducts were found to contain five large flatworms, also known as flukes, during a cholangioscopy performed during cancer surgery.
