A Case of Preoperatively Diagnosed Intraabdominal Abscess Caused by Fish Bone Ingestion

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  • 術前CTで診断し得た穿孔部位不明の魚骨による腹直筋直下腹腔内膿瘍の１例
  • ジュツゼン CT デ シンダン シエタ センコウ ブイ フメイ ノ ギョコツ ニ ヨル フクチョクキンチョクシタハラ クウナイ ノウヨウ ノ 1レイ

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Abstract

A 59-year-old man consulted a local doctor after 4 days of abdominal pain. The patient had tenderness and a mass in the left umbilical region. The presence of a rectus abdominis muscle abscess was not likely, but the patient was admitted to our hospital. A computed tomographic scan taken at the nearby clinic showed an 8 × 5 cm multilocular cystic mass with a linear area of high density. The abscess cavity and intestinal tract wall were not consecutive, but we thought that the abscess was caused by ingesting a fish bone. Laparotomy revealed that the abscess had damaged the left rectus abdominis muscle sheath and peritoneum, and the abscess cavity commuted with the abdominal cavity. We recognized an approximately 4-cm-long fish bone in the abscess cavity. The greater omentum covered the abscess in the abdominal cavity and adhered to the peritoneum. We examined the small intestine and colon, but found no perforation. We determined postoperatively that the patient had eaten fried salmon several days before the onset of pain. The patient was complicated by a wound infection, but was discharged on postoperative day 21.

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