A 72-year-old woman underwent laparoscopic removal of a 4-cm fish bone from her liver after conservative antibiotic treatment failed, Cureus reported.
The patient sought care at an emergency department citing a three-day history of right-sided abdominal pain, nausea, and a maximum temperature of 38.5 °C.
Computed tomography scans revealed a thin, linear foreign body in hepatic segment V near the gallbladder bed. The imaging also showed inflammatory changes in the second portion of the duodenum, pointing to a contained duodenal perforation that sealed through local inflammatory reactions.
Physicians initially treated the patient with intravenous piperacillin-tazobactam because she remained clinically stable and lacked signs of peritonitis.
Serial computed tomography scans after one week and three weeks, however, demonstrated progressive hepatic collections alongside a retained intrahepatic foreign body. Interventional radiology deemed percutaneous drainage technically unfeasible, prompting surgeons to pursue definitive source control.
Surgeons performed a cholecystectomy during the operation to expose the gallbladder bed and safely extract the 4–cm foreign body laparoscopically without requiring hepatic resection. Follow-up ultrasonography confirmed complete clinical resolution with no residual focal hepatic lesions.
Questions about fish bone ingestion and diagnosis
Why did the patient not remember swallowing a fish bone?
Patients frequently fail to recall ingestion events when sharp foreign bodies pass through the upper gastrointestinal tract unnoticed. In enterohepatic migration cases, symptoms often emerge weeks later as localized infections develop.
How did doctors diagnose the migrated foreign body?
Computed tomography served as the primary diagnostic modality. Scans identified a linear hyperdense foreign body within hepatic segment V alongside associated hepatic collections and duodenal wall thickening.
What surgical approach removed the foreign body?
Surgeons used a laparoscopic approach combined with a cholecystectomy to gain adequate exposure to the gallbladder bed. This procedure allowed the safe extraction of the 4-cm fish bone without liver resection.
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