Fish bone: unusual cause of liver abscess

A 41-year-old female admitted to our department of general surgery with a three days history of abdominal pain, fever and shivering. She was previously healthy without any past medical history.

On examination, she was febrile at 39°C, and she had tenderness in the epigastric quadrant of the abdomen. Biological data showed leukocytosis at 22.10³ E/L, high C - reactive protein at 300mg/L, normal amylase and liver enzymes.

The abdominal CT scan revealed a 5 cm left hepatic lobe abscess with hyperdense image into parenchyma which matches a 2 cm linear structure with calcium density (Figure1). After ten days of intravenous antibiotics, an exploratory laparoscopy was done, and the foreign body was extracted (Figure 2).

Some liver abscess were due to the perforation and migration of a foreign body from the gastric antrum, pylorus or first and second duodenum [1]. This etiopathogenic mechanism explains the left site of the hepatic abscess in these conditions. The extraction of the foreign body which can be chicken bones [2], toothpicks or other is done either by endoscopy when there is an intra-luminal part of this foreign body or by minimally invasive surgery as in our case [3].