Joao Pedro Araújo Teixeira (Porto / PT), Jorge Nogueiro (Porto / PT), Miguel Machado (Porto / PT), Miguel Almeida (Porto / PT), Virgília Gomes (Porto / PT), Cristina Fernandes (Porto / PT), Rui Mendes Costa (Porto / PT), Luís Graça (Porto / PT), Elisabete Barbosa (Porto / PT)
Abstract text (incl. references and figure legends)
We hereby present two cases of liver abscess caused by ingestion of fisherbones.Case 1:62 year old man brought by severe prostration.He presents with respiratory distress, severe hypotension, tachycardia and neurological dysfunction.Case 2:58 year old woman admitted with fever, epigastric pain, nausea and vomiting during the course of 3 days.Blood analysis showed leucocytosis and elevation of CRP in both cases. In the first case, there was also kidney and liver injury with hyperbilirubinemia. CT scans were performed, showing heterogeneous lesions located in the segments III and IVb measuring 90x75mm and 36x43mm, respectively. Additionally, an endoscopic ultrasonography was performed on the second case.According to clinical and radiological findings, a liver abscess was diagnosed in relation with the presence of a foreign body, in both cases.The first was submitted to emergent drainage due to its critical state.The second was proposed to urgent surgery due to its unresponsiveness to antibiotics.Percutaneous drainage was neither available or successful.Both went under laparoscopic drainage and removal of the fishbone in the emergency OR.The pos-operative course was uneventful and antibiotics were adjusted accordingly.The patients were discharged 20 and 9 days after surgery, respectively.We believe these liver abscess were caused by perforation and migration of an ingested fishbone through the stomach/duodenum and reaching the liver.Less than 1% of ingested bodies cause perforation and rarely cause liver abscess, although its incidence is increasing.Because the mortality is high, emergent drainage must be considered and, preferably, minimally invasive, as performed in these cases.
References:
Leggieri N, et al.[Migrated Foreign Body Liver Abscess-Ilustrative case report, systematic review and proposed diagnostic algorithm. Medicine 2010; 89: 85-95
Graça L, Viamonte B, Carvalho C, et al.BMJ Case Rep 2019; 12:e230452. doi: 10.1136/bcr-2019-230452
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