Liver abscess caused by the ingested foreign body without sign of gastrointestinal perforation: A case report

The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.