
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38171867
10.2169/internalmedicine.3037-23
Pictures in Clinical Medicine
Fishbone Perforation and Liver Abscess
Imataki Osamu 1
Uemura Makiko 1
1 Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Japan
Correspondence to Dr.　Osamu Imataki, imataki.osamu@kagawa-u.ac.jp

2 1 2024
15 8 2024
63 16 23372338
11 10 2023
13 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
fishbone perforation
fishbone migration
liver abscess
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pmcAn 81-year-old Japanese woman complained of nausea for 4 days. She visited our hospital with a fever of 38.9°C (102°F). She had a tender abdominal mass. Laboratory tests indicated inflammation with liver damage, as follows: white blood cells 20,000/μL, C-reactive protein 22.56 mg/dL, aspartate aminotransferase 65 IU/L, and alanine aminotransferase 90 IU/L. Computed tomography (CT) revealed a linear high-density lesion in the lesser curvature of the stomach and cystic lesion in the lateral segment of the liver (Picture a, b). Ultrasonography identified linear hyperechoic foreign bodies 30 and 9 mm long (Picture c). When interviewed, the patient recalled eating salted, dried horse mackerel one day before her symptoms began; however, she did not remember swallowing a fishbone. We concluded that the patient had experienced gastric perforation and liver abscess caused by fish bone migration. However, gastric endoscopy revealed no mucosal damage. Blood and liver abscess cultures detected the Streptococcus milleri group. The patient's condition was relieved with piperacillin without removal of any fishbones.

Picture.

Written informed consent was obtained from the patient for the publication of this study (including the publication of images).

The authors state that they have no Conflict of Interest (COI).

Financial Support

This work was supported by JSPS KAKENHI (grant number JP23K11850).
