Perivesical abscess caused by migration of a fish bone from the intestinal tract

Development of an abdominal wall abscess caused by fish bone ingestion: a case report

Background

A small percentage of patients with foreign body ingestion develop complications, which have a variety of clinical presentations. Less than 1% of cases require surgical intervention. We present a patient with an abdominal wall abscess resulting from a fish bone that pierced the cecum. The patient was treated laparoscopically.

Case presentation

A 55-year-old Japanese man presented to our hospital with a complaint of right lower abdominal pain. A physical examination revealed tenderness, swelling, and redness at the right iliac fossa. Computed tomography showed a low-density area with rim enhancement in his right internal oblique muscle and a hyperdense 20 mm-long pointed object in the wall of the adjacent cecum. Based on the findings we suspected an abdominal wall abscess resulting from a migrating ingested fish bone. He was administered antibiotics as conservative treatment, and the abscess was not seen on subsequent computed tomography.

Two months after the initial treatment, he presented with the same symptoms, and a computed tomography scan showed the foreign body in the same location as before with the same low-density area. We diagnosed the low-density area as recurrence of the abdominal wall abscess. He underwent laparoscopic surgery to remove the foreign body. His appendix, and part of his cecum and the parietal peritoneum that included the foreign body, were resected. He had an uneventful postoperative course, and at 1 year after the surgery, the abdominal wall abscess had not recurred.

Conclusions

An abdominal wall abscess developed in association with the migration of an ingested fish bone. We suggest that a laparoscopic surgical resection of the portion of the bowel that includes the foreign body is a useful option for selected cases.

Right-sided hydronephrosis secondary to swallowing a headscarf pin

A majority of foreign objects ingested pass through the gastrointestinal tract without any complications. Sometimes, complications such as perforation and adhesions of the neighboring organs occur and surgical treatment becomes necessary. We report the case of a 22-year-old female who was admitted with right flank pain. Past medical history revealed that the patient had accidentally swallowed a headscarf pin 11 months earlier. A computed tomography scan confirmed the swallowed foreign body posterior to and around the ileocecal region. The headscarf pin, causing stenosis and proximal ureteral dilatation, was removed surgically. To the authors' knowledge there has been no previous report of such ureteral obstruction published in the English literature.

A misdiagnosed cause of chronic pelvic pain: abscess with foreign body

OBJECTIVE

Chronic pelvic pain may present a diagnostic challenge.

SETTING

Academic tertiary care center.

DESIGN

Case report.

CASE REPORT

A 46-year-old woman presented with pain on micturition and a 15-month history of right-sided pelvic pain aggravated by an abdominal massage. Her course and outcome, aided by use of computed tomography (CT) scan, is described, identifying a 6-cm, mass-like lesion in the right lower quadrant enclosing an ambiguous linear calcified lesion, which on laparotomy revealed a fish bone embedded in a section of the terminal ileum and the perivesical area.

CONCLUSION

Chronic pelvic pain refractory to treatment merits consideration of CT to examine for foreign body.

Successful endoscopic management of fish bone embedded into the bladder wall

We report a case of a pyogenous vesical abscess resulting from an ingested fish bone embedded in the bladder wall that was treated endoscopically in an asymptomatic man. Computed tomography of the abdomen showed a linear radiopaque structure in the thickened left anterolateral wall of the bladder. Cystoscopy revealed a protruding mass, covered with normal-appearing mucosa, with outflow of pus from a shallow recess. Histopathological findings indicated that the transurethrally removed linear structure, located in the submucosa, was compatible with fish bone. A high index of suspicion should be maintained for the correct diagnosis to be made.

Hydronephrosis caused by intra-abdominal abscess from cecal perforation by an ingested fish bone

A patient was treated for hydronephrosis caused by an intra-abdominal abscess arising from cecal perforation by an ingested fish bone. To the authors' knowledge there is no previous report of such ureteral obstruction. Ureteral stenting, drainage of the abscess, and ileocecal resection were performed. Six months of stenting were required to attain ongoing ureteral patency following removal.

Fish bone as a nidus for stone formation in the common bile duct: report of two cases

We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.