piperacillin--tazobactam-drug-combination and Foreign-Body-Migration

Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ.

Topics: Abdominal Pain; Animals; Anti-Bacterial Agents; Bone and Bones; Diagnosis, Differential; Drug Therapy, Combination; Female; Foreign Bodies; Foreign-Body Migration; Humans; Liver Abscess; Metronidazole; Middle Aged; Piperacillin, Tazobactam Drug Combination; Seafood; Tomography, X-Ray Computed

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient's upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient's hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

Topics: Abdominal Abscess; Abdominal Pain; Aged; Anticoagulants; Diagnosis, Differential; Enterobacteriaceae Infections; Foreign-Body Migration; Heparin; Humans; Male; Piperacillin, Tazobactam Drug Combination; Portal Vein; Streptococcal Infections; Thrombosis; Tomography, X-Ray Computed