Intra-abdominal abscess as a rare and delayed consequence of fish bone ingestion in a diabetic patient: A case report

Abstract

Introduction: Foreign body ingestion is a common clinical occurrence, particularly among children, the elderly, and individuals with psychiatric disorders. While most objects pass harmlessly through the gastrointestinal (GI) tract, sharp items such as fish bones can cause severe complications such as perforation, abscess formation, and peritonitis. Early recognition is essential to avoid life-threatening outcomes.

Case presentation: A 45-year-old man presented with severe right lower quadrant abdominal pain, fever (38.5 °C), and nausea, 10 days after experiencing mild throat discomfort following fish consumption. Physical examination revealed tenderness and guarding in the right iliac fossa. Computed tomography (CT) identified a linear foreign body within a localized abscess cavity that was adherent to the abdominal wall.

Discussion: Intra-abdominal abscess secondary to gastrointestinal perforation by a fish bone is an uncommon but clinically significant complication. It often presents with vague and nonspecific symptoms, such as low-grade abdominal discomfort and mild gastrointestinal upset, which can lead to delays in diagnosis and treatment. In this case, the patient's underlying diabetes mellitus likely blunted the typical systemic inflammatory response, further masking the severity of the condition and contributing to a delayed presentation. This highlights the diagnostic challenge posed by foreign body ingestion in patients with comorbidities that alter immune or inflammatory responses. Contrast-enhanced computed tomography (CT) played a crucial role in identifying the radiolucent foreign body, delineating the extent of the abscess, and guiding the decision for surgical intervention. The successful use of a minimally invasive laparoscopic approach in this setting demonstrates its value in both confirming the diagnosis and achieving effective source control, with favorable recovery and outcome.

Conclusion: This report underscores the importance of maintaining a high index of suspicion in patients with atypical abdominal pain and risk factors for foreign body ingestion, and highlights the efficacy of early imaging and minimally invasive surgical management in optimizing clinical outcomes.

Keywords: Acute abdomen; Case report; Fish bone ingestion; Intra-abdominal abscess; Surgical intervention.

Fig. 1

Coronal CT view of the abdomen - intra-abdominal abscess involving the omental fat and extending to the abdominal wall.

Fig. 2

Axial CT view of the abdomen - Intraabdominal Abscess with a fish bone identified within the abscess.

Fig. 3

Intraoperative Image showing the laparoscopic Drainage of the Abscess.

Fig. 4

Another Intraoperative Image showing the laparoscopic extraction of the Fish Bone.

Fig. 5

Fish bone after extraction.