Antoine Sassine, MD, MBA, Tayyab Shabbir, MD, Rebecca Klesmith, DO Trinity Health Grand Rapids, Grand Rapids, MI
Introduction: Liver abscesses are rare but potentially life-threatening conditions arising from various etiologies, including foreign body ingestion. We present a case report of a liver abscess resulting from suspected fishbone ingestion in a 64-year-old female with no known underlying liver disease.
Case Description/Methods: The patient presented to the emergency department with complaints of epigastric pain. On initial workup, she was found to have neutrophilic leukocytosis and mild elevations in total bilirubin and aspartate aminotransferase. CT of the abdomen was performed, which revealed a large complex cystic lesion with multiple thick internal septae measuring 12 x 9 cm in the left lobe of the liver. Two days later, the patient became septic and had an acute drop in hemoglobin from 8.5 g/dl to 6.5 g/dl. Concerned for an intra-abdominal bleed, a repeat CT abdomen pelvis was obtained, showing a persistent cystic mass. In addition, a very thin linear density, a suspected fishbone, was found extending from the posterior hepatic capsular margin adjacent to the gastric antrum into the center of this lesion. MRCP was then performed, which favored the diagnosis of a large multiseptated hepatic abscess. Antibiotics were adjusted, and the patient subsequently underwent laparotomy with incision and drainage, partial intrahepatic foreign body removal, and hepatic JP drain placement. Cultures obtained intraoperatively grew streptococcus constellatus. Four days later, the patient's sepsis resolved, and she was discharged on long-term antibiotics.
Discussion: This case report emphasizes the importance of considering foreign body ingestion as a potential cause of liver abscess in patients who present with suggestive symptoms, particularly left-sided abscesses. Appropriate imaging and early intervention are critical to achieving a favorable outcome in such cases.
Figure: Sagittal (A,C) and axial (B) views of fishbone associated hepatic abscess. Fishbone extending from the posterior hepatic capsular margin into the center of the abscess (red arrows).
Disclosures:
Antoine Sassine indicated no relevant financial relationships.
Tayyab Shabbir indicated no relevant financial relationships.
Rebecca Klesmith indicated no relevant financial relationships.
Antoine Sassine, MD, MBA, Tayyab Shabbir, MD, Rebecca Klesmith, DO. P4754 - A Fishy Case of Hepatic Abscess, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
