CT diagnosis and laparoscopic treatment of hepatic abscess secondary to fish bone transmigration through the stomach wall

Accidental ingestion of fish bones can potentially lead to serious complications like perforation of the alimentary tract and the formation of abscesses in adjacent organs. Prompt and accurate diagnosis of the etiology of hepatic abscesses is critical to prevent clinical deterioration and poor outcomes. Notably, fish bones can be subtle in imaging studies and erroneously interpreted as calcifications, vessels, or artifacts potentially delaying diagnosis and management. Further complicating medical management, fish bones can be seeded with oral microflora which may not be effectively targeted by empiric antibiotics. Patients presenting with an occult hepatic abscess often have repeated visits to the emergency department with vague symptomology and abdominal pain without recollection of any precipitating events. In this case report, a multidisciplinary approach, including a high index of suspicion applied to CT imaging, was vital in identifying a foreign body within an abscess localized between the greater curvature of the stomach and left liver lobe. The foreign body, mimicking an intraperitoneal calcification, was a fish bone that had transmigrated through the stomach wall into the liver lobe. Once identified, definitive treatment included laparoscopic drainage of the abscess, extraction of the foreign body, and coverage with broad-spectrum antibiotics.