Fish Bone Penetration Research Articles

Fishbone Penetration Causing Liver Abscess

Fishbone Penetration Causing Liver Abscess

A rare cause of hepatic abscess: Fish bone penetration leading to abscess formation

Abstract Liver abscesses due to foreign body penetration from the gastrointestinal tract are relatively rare events. The inability to recognize this condition may lead to poor response to standard treatment of liver abscesses. This group of liver abscesses has a distinct location and growth of microorganisms from liver abscesses of other etiologies. Laboratory studies often present nonspecific findings. Computed tomography exam is the best tool to recognize and diagnose this condition. Treatment often would require foreign object removal to prevent the recurrence of abscess formation.

Pancreatic abscess: a modern look at an old problem

analysis of morphological and etiologic characteristics and clinical features of pancreatic abscesses on the basis of previous publications. Theoretical analysis and generalization, classification, analysis of scientific and methodical literature. The analysis of the literature was carried out using electronic scientometric database Scopus, Web of Science, Ulrich's Periodicals, Google Scholar, PubMed, Medline. We analyzed literary sources publicated since 1909, using the keywords, such as: pancreatic abscess, abscess of pancreas. Articles published in professional English-language journals were included. Were analyzed publications dedicated to acute pancreatitis, chronic pancreatitis, infected pseudocysts as a cause of pancreatic abscess. We analyzed scientific works concerning benign and malignant tumors of pancreaticoduodenal area, scientific papers concerning fish bone penetration into the pancreas. Causes of pancreatic abscess development such as trauma of the pancreas, thrombosis of a.lienalis and pancreas divisum were described in the publication for the first time. Other scientific works are devoted to infectious agents, diagnosis and treatment of abscesses. Pancreatic abscess is the body's response to pancreatic infection that is characterized by specific morphological structure and heterospecific etiology. Pancreatic abscess is the transition state that combines acute destructive (acute infected necrotizing pancreatitis) and chronic degenerative (a chronic fibrotic-degenerative pancreatitis complicated by the pancreatic pseudocyst) pancreatitis. Pancreatic abscess can be considered as the marker of chronization of inflamantory and destructive pathological processes that need etiologic authentication and further treatment.

Two cases of gastric penetration by fish bones with differing courses

ABSTRACTMost foreign bodies swallowed accidentally are naturally excreted. Gastric penetration by a fish bone is rare due to anatomical and physiological features such as the thick stomach wall, wide lumen and gastric acid. The most common penetration site is the antral region. The clinical course of fish bone penetration of the gastric antrum may differ depending on the direction of penetration. In this report, two cases of gastric perforation by fish bones that followed different courses are presented. One case was treated conservatively with antibiotics alone, and another case was considered for surgery, due to increased hematoma and penetration of the fish bone into the pancreas. However, the patient’s comorbidities were so severe that surgery was not possible, resulting in meticulous follow-up. Diagnostic imaging was important in these cases.

A case of lingual abscess caused by an infection stemming from fish bone penetration

A case of lingual abscess caused by an infection stemming from fish bone penetration

Preoperatively Diagnosed Case of Amyand Hernia and Fish Bone Penetration of the Appendix Treated with Laparoscopic Appendectomy

症例は83歳の男性で，1か月前からの右鼠径部腫瘤を主訴に当科に紹介となった．超音波検査，腹部CTで鼠径ヘルニアの内容が虫垂であるAmyand hernia，虫垂魚骨穿通と診断した．急性腹症の所見はなく，外来での経過観察となった．1週間後も同様の所見を認め，待機的に腹腔鏡下虫垂切除術を行った．ヘルニア囊への虫垂の癒着があったが，ヘルニア囊を内反させることで虫垂および魚骨を切除することができた．鼠径ヘルニアに対する手術希望はなく，ヘルニア根治術は行わず終診となった．Amyand hernia，虫垂魚骨穿通はともにまれであり，術前に診断されることは少なく開腹下に緊急手術されることが多い．今回，Amyand herniaと虫垂魚骨穿通を術前診断し，待機的に腹腔鏡下虫垂切除術を行った症例を経験したので報告する．

Laparoscopic removal of an ingested fish bone that penetrated the stomach and was embedded in the pancreas: a case report

BackgroundThe gastrointestinal tract can occasionally be perforated or penetrated by an ingested foreign body, such as a fish bone. However, there are very few reported cases in which an ingested fish bone penetrated the gastrointestinal tract and was embedded in the pancreas.Case presentationAn 80-year-old male presented with epigastric pain. Computed tomography of the abdomen showed a linear, hyperdense, foreign body that penetrated through the posterior wall of the gastric antrum. There was no evidence of free air, abscess formation, migration of the foreign body into the pancreas, or pancreatitis. As the patient had a history of fish bone ingestion, we made a diagnosis of localized peritonitis caused by fish bone penetration of the posterior wall of the gastric antrum. We first attempted to remove the foreign body endoscopically, but failed because it was not detected. Hence, an emergency laparoscopic surgery was performed. A linear, hard, foreign body penetrated through the posterior wall of the gastric antrum and was embedded in the pancreas. The foreign body was safely removed laparoscopically and was identified as a 2.5-cm-long fish bone. Intraperitoneal lavage was performed, and a drain was placed in the lesser sac. The patient recovered without complications and was discharged on the 7th postoperative day.ConclusionLaparoscopic surgery could be performed safely for the removal of an ingested fish bone embedded in the pancreas.

Surgical strategy for the treatment of aortoesophageal fistula

ObjectiveTo present a surgical strategy for aortoesophageal fistula (AEF). MethodsFrom October 1999 to May 2017, 27 patients with AEF were treated at Kobe University Hospital. After 9 patients with malignancies or fish bone penetration were excluded, 18 patients who had AEF secondary to aortic lesions were investigated. The mean age was 67.2 ± 10.4 years, and the male/female ratio was 16:2. Twelve patients had a nondissection thoracic aneurysm, and 6 patients had a chronic aortic dissection. Six patients were in shock. Seven patients had a previous thoracic endovascular aortic repair (TEVAR) in the descending aorta, 2 patients had descending aorta replacement, 1 had hemiarch replacement, and 2 had total arch replacement. As the first treatment for AEF, 3 patients underwent TEVAR as destination therapy, 3 patients had a bridge TEVAR to open surgery, 1 patient had an extra-anatomical bypass from the ascending aorta to the abdominal aorta, and 11 patients had an in situ reconstruction of the descending aorta. The esophagus was resected in 16 patients, and an omental flap was installed in 16 patients. Additional procedures were extra-anatomical bypass in 2 patients and in situ reconstruction of the aorta in 3 patients. ResultsHospital mortality was noted in 4 patients (22.2% persistent sepsis, n = 3: pneumonia, n = 1). However, since 2007, only 1 of 13 patients has died (pneumonia). Late death occurred in 5 patients, due to pneumonia, cerebral bleeding, diarrhea, sudden death, and persistent infection. Actuarial survival was 42.4 ± 12.8% at 5 years and freedom from aorta-related death was 59.4 ± 13.5% at 5 years. Nine patients achieved completed reconstruction of the esophagus 172 ± 57 days after initial surgery. ConclusionsAlthough a comparative study was not performed, 1-stage surgery consisting of resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta, and omental flap installation provided a better outcome in the treatment for AEF. Bridging TEVAR to the open surgery is a useful adjunct in patients with AEF with hemorrhagic shock. Later reconstruction of the esophagus can be performed in the survivors.

Successful Treatment of Fish Bone Penetration of the Duodenum with Hepatic and Abdominal Abscess

症例は75歳，女性．食欲低下を主訴に近医を受診し，精査加療目的に紹介となった．当院入院時の血液検査ではWBC 36,400/μl，CRP 28.40mg/dlと高値であり，さらに肝逸脱酵素の軽度上昇も認められた．腹部CT上，肝内側区域に径50×60mmの肝膿瘍が認められた．さらに，肝外には十二指腸から穿通した魚骨と考えられる線状の石灰化陰影とその周囲に膿瘍形成が認められた．以上より穿通した魚骨により肝膿瘍と腹腔内膿瘍が形成されたと診断し，経皮的穿刺ドレナージにて肝膿瘍の改善を図った後，腹腔鏡下に魚骨を摘出した．摘出された魚骨は長さ30mmであった．魚骨穿通による肝膿瘍の報告例は非常に稀であるため，若干の文献とともに報告する．

A Case of Fish Bone Penetration of the Small Intestine in a Patient with Essential Thrombocythemia

A Case of Fish Bone Penetration of the Small Intestine in a Patient with Essential Thrombocythemia

長期間無症候であった穿孔部位不明の魚骨による腹直筋下腹腔内膿瘍の１例

長期間無症候であった穿孔部位不明の魚骨による腹直筋下腹腔内膿瘍の１例

Sepsis of Unknown Origin Secondary to Liver Abscess Caused by Fish Bone Migration

The authors present the case of a woman of 80 years of age, without relevant medical history, which presented to the emergency department for fever (38-39°C), chills, nausea and vomiting, and persistent pain in the right hypochondrium lasting for two days. Initial clinical assessment revealed hypotension, hypoxemia (pO2 < 70mmHg), slight leukocytosis, CRP 176mg/L and increased lactates (3.0mmol) and the imaging studies (chest X-ray and abdominal CT) showed no change. Then the patient was hospitalized in intermediate care unit where she was started on antibiotics with a diagnosis of sepsis of unknown origin. Two days after, the patient was clinically better but maintained abdominal complaints and so it was performed a new abdominal CT scan where we were able to identify a linear foreign body with approximately 30mm perforating the intestinal wall at the level of the pylorus, contacting with the hepatic parenchyma where a multiloculated abscess with 44mm was seen (figure 1 [arrow]). After further conversation with the patient, it was found to be of a fishbone ingested days before. Consequently, an upper endoscopy was performed where it was found a swollen area in the antero-superior duodenal bulb wall with a central fistulous opening (figure 2). After discussion with the surgical team it was decided to maintain a conservative strategy (antibiotics plus imaging surveillance). Once there was gradual improvement of the clinical picture, the patient was transferred to the surgery ward and then discharged to outpatient consultation.Figure 1Figure 2A myriad of ingested sharp-pointed objects have been described and not always the patients are aware of foreign body ingestion, and in these cases the diagnosis is only made on the occurrence of complications, such as in the reported case. Cases of hepatic abscess due to fish bone penetration are very rare and may be fatal. Since the first reported case, treatments usually include drainage of the abscess, removal of the foreign body, and administration of appropriate antibiotics. Surgery is considered the treatment of choice in current clinical practice, but when the diagnosis is not initially suspected, and if the patient shows clinically improvement, a conservative approach can be attempted. In this case, once the patient was better under empirical antibiotics we preferred not to submit the patient to a surgical procedure. So we suggest that medical approaches could be attempted first in such cases.

Strategies for the treatment of aorto-oesophageal fistula†

Presenting a surgical strategy for aorto-oesophageal fistula (AEF). From October 1999 to August 2013, 16 patients with AEF were treated at Kobe University Hospital. The mean age was 65.5 ± 10.2 years, and the male/female ratio was 13/3. Eight patients had non-dissecting thoracic aneurysm, 3 had chronic aortic dissection, 5 had oesophageal cancer and 1 had fish bone penetration. Five patients were in shock. Four patients had previous thoracic endovascular aortic repair (TEVAR) in the descending aorta and 1 had hemi-arch replacement. As treatment for AEF, 8 patients underwent TEVAR, 2 had a bridge TEVAR to open surgery, 2 had extra-anatomical bypass (EAB) and 5 had in situ reconstruction of the descending aorta. The oesophagus was resected in 8 patients, and an omental flap was installed in 7 patients. For the 4 most recent cases, simultaneous resection of the aorta and oesophagus, in situ reconstruction of the descending aorta using rifampicin-soaked Dacron graft and omental flap installation were performed. Hospital mortality was noted in 4 patients (25.0%; persistent sepsis n = 3 and pneumonia n = 1). However, since 2007, only 1 of 5 patients died (pneumonia). All patients with oesophageal cancer died during follow-up. Two patients underwent oesophageal reconstruction using a pedicled colon graft and one is on the waiting list for oesophageal reconstruction. Bridging TEVAR is a useful adjunct in treating AEF patients with shock. One-stage surgery consisting of resection of the aneurysm and oesophagus, in situ reconstruction of the descending aorta and omental flap installation provided a better outcome in the AEF surgical strategy compared with conservative treatment.

腹腔鏡下に手術した魚骨横行結腸穿通による大網放線菌症の1例

腹腔鏡下に手術した魚骨横行結腸穿通による大網放線菌症の1例

Fishbone penetration of the thoracic esophagus with prolonged asymptomatic impaction within the aorta

A 54-year-old man with fishbone penetration of the thoracic esophagus and mediastinal hematoma was successfully managed with conservative treatment. Six-month follow-up computed tomography (CT) revealed migration of the fishbone into the aorta; however, the patient was asymptomatic and refused surgery. Six years later, CT showed persistent impaction of the fishbone within the aorta, but the patient was healthy. To our knowledge, this is the first reported case of serial CT documentation of fishbone penetration of the esophagus with migration into and prolonged asymptomatic impaction within the aorta.

Fish-Bone Penetration of the Gastrointestinal Tract Extending into the Pancreas: Report of Two Cases

Most ingested foreign bodies pass through the gastrointestinal tract uneventfully within 1 week of ingestion, and so gastrointestinal tract perforation is rare, occurring in less than 1% of patients. The occurrence of a pancreas penetration secondary to foreign-body perforation is even rarer. Here we report two cases of foreign-body penetration of the gastrointestinal tract extending into the pancreas and retroperitoneum. The findings of these cases serve to remind all clinicians that the diagnosis of a foreign-body perforation should always be kept in mind in a patient with abdominal symptoms, and physicians should endeavor to determine the history of ingestion and be aware of foreign bodies in CT scans. (Korean J Med 2012;82:718-723)

A Fish Bone-Related Hepatic Abscess

We report an unusual case of pyogenic, hepatic abscess caused by fish bone penetration of the duodenum in a 68-year-old woman. The fish bone had migrated into the liver through the duodenal wall. The patient was initially admitted to our emergency room with abdominal pain, fever, and asthenia. A contrastenhanced abdominal coputed tomography (CT) scan showed a hepatic abscess in relation with a straight, foreign body, which had entered through the duodenal wall. Surgery was necessary to remove the foreign body, which was identified as a fish bone. The patient's recovery was uneventful and she was discharged on postoperative day 10. This case is discussed together with the data collected by a medline-based extensive review of the literature.

Colon Perforation by an Ingested Bone

A 60-year-old man presented to the Emergency Department (ED) due to progressive left abdominal pain over 1 month. Physical examination showed a temperature of 36.8 C, a heart rate of 84 beats/min, and a blood pressure of 150/80 mm Hg, as well as a soft abdomen with left abdominal tenderness and rebound tenderness. The laboratory evaluation disclosed a white blood cell (WBC) count of 7400/mm with 83.9% segmented neutrophils. Abdominal computed tomography showed focal abscess formation in the left abdomen (Figure 1, white arrow) containing a thin rod-like high-density material (Figure 1, black arrow). Explorative laparotomy revealed an abscess adhesion between the transverse and descending colon. A granulation scar-like lesion was seen at the transverse colon. The pathologist found a suspected fish bone measuring 33 mm in the abscess. Fish bone penetration and a sealed-off perforation were suspected. The patient was discharged uneventfully 7 days postoperatively.

ドレナージ術にて治癒した魚骨穿通による後腹膜膿瘍の2例

ドレナージ術にて治癒した魚骨穿通による後腹膜膿瘍の2例

Fish bone penetration of the duodenum extending into the pancreas: Report of a case

We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas.