Hepatic abscess induced by foreign body: case report and literature review

Abstract

Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.

Figure 1

Contrast en-hanced CT scan showing a low-density area with gas and fluid, measuring approximately 8.5 cm x 7.0 cm, consistent with left-sided intra-hepatic abscess.

Figure 2

Abdominal RM demonstrating a large collection with gas and fluid.

Figure 3

Biopsy of the liver abscess showing fibrosis, fibrin and acute inflammatory cells, consistent with abscess wall (HE).

Figure 4

Upper GI endoscopy revealing a thickened gastric fold (pre-pyloric).

Figure 5

Removed foreign body (chicken bone, with 3.3 cm x 0.5 cm).