A Case of Liver Abscess and Cardiac Tamponade Due to Fishbone Perforation

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  • 魚骨穿孔から肝膿瘍・心タンポナーデへ至った1例
  • ギョコツ センコウ カラ カン ノウヨウ ・ シン タンポナーデ エ イタッタ 1レイ

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Abstract

<p>A man in his 80s was transferred to our emergency department with the chief complaint of high fever. Abdominal contrast-enhanced CT after admission revealed a 5-cm abscess with a fishbone in the left lateral segment of the liver, so that we diagnosed the patient as having an abscess caused by fishbone perforation. We immediately performed percutaneous transhepatic abscess drainage. The blood pressure declined suddenly seven days later, and CT revealed migration of the fishbone to the pericardial space and pericardial effusion. We made the diagnosis of cardiac tamponade due to fishbone perforation of the pericardium and performed an emergent operation. Intraoperatively, the fishbone was found to be protruding from the gastric wall and penetrating the hepatic surface in the left lateral segment and the subphrenic membrane. We removed the fishbone and drained about 200 mL of old blood from a pinhole made in the subphrenic membrane. We performed left lateral segmentectomy of the liver and pericardial drainage. The patient was discharged 15 days after the operation without any significant complications. Although cardiac tamponade due to fishbone perforation is usually secondary to esophageal injury, a fishbone migrating into the left lateral segment of the liver can also penetrate the subphrenic membrane, causing damage to the pericardial membrane and potentially, cardiac tamponade.</p>

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