Liver abscess secondary to a broken needle migration--a case report

Abstract

Background: Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain.

Case report: A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery.

Conclusion: It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.

Figure 1

Abdominal x-ray (AP view) showing the needle in the region of the liver

Figure 2

Ultrasound of the abdomen showing the abscess and the needle in the right lobe of the liver

Figure 3

Contrast enhanced computed scan of the abdomen showing the abscess and needle in the right lobe of the liver

Figure 4

The sewing needle after retrieval