Danish doctors have cured a man whose swallowed fish bone had penetrated his liver and caused an abscess. In this rare case, antibiotic therapy was sufficient without surgery. The case report is published in the journal BMJ Case Reports.
Typical causes of liver abscess (suppuration with cavity formation) are complications of cholangitis, penetration of purulent infection with blood or from surrounding tissues and trauma. Foreign objects are rarely mentioned as an etiological factor, fish bones are extremely rare among them. As a rule, laparoscopy or removal of a part of the liver is used to treat such abscesses, in isolated cases only antibiotic treatment helps. Usually patients can be cured, but penetration of a fish bone can lead to severe sepsis with a fatal outcome.
A man in his 60s was admitted to Copenhagen University Hospital by Luit Penninga and colleagues with a 10-day history of intermittent fever. He had no other symptoms except for a red spot on his neck. The doctors suspected erysipelas (a streptococcal skin infection) and prescribed antibiotics. The patient's temperature continued to rise cyclically over the next six days, and laboratory tests showed active inflammation - the treatment was not effective.
In search of the source of infection, the man underwent a CT scan of the internal organs and an eight-centimeter abscess with a radiographically dense object inside was found in the left lobe of the liver. The antibiotic therapy was changed to intravenous piperacillin with tazobactam and metronidazole (this combination has a broad spectrum of action on pathogens of the abdominal cavity). An attempt was also made to drain the abscess under ultrasound control, but it was not successful.
Antibiotic therapy was continued for four weeks, and no signs of the disease were observed by this time. Three months later, the patient underwent a repeat CT scan. It showed that 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 that it was a swallowed fish bone. The adhesion of the stomach wall to the liver in the area of the abscess, which probably occurred at the site of bone penetration, also supported the conclusion. Since the man had no symptoms, specialists decided not to remove the foreign object so as not to cause additional damage to the liver and other organs.
Earlier, Chinese doctors shared the case of a 70-year-old patient who had five large flatworms, flukes, found in his bile ducts during a cholangioscopy during an oncological operation.