Occult transgastric fish-bone migration causing delayed left hepatic abscess: serial computed tomography findings and a missed diagnostic opportunity.
- 1Department of Radiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
- 2Department of Ultrasound, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
- 3Department of General Surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
Abstract
Ingested fish bones rarely perforate the gastrointestinal tract and migrate into the liver, and the diagnosis may be delayed when ingestion is not recalled and the perforation is locally contained. We report a 45-year-old man who presented with 9 days of intermittent fever, upper abdominal distension, and frequent belching. Ultrasonography demonstrated a large complex collection in the left hepatic lobe with an internal echogenic focus. Non-contrast computed tomography showed a multiloculated left-lobe abscess containing a 5-cm linear hyperattenuating foreign body, focal discontinuity of the gastric antral wall, and hepatogastric inflammatory adhesion. Retrospective review of a chest computed tomography examination performed approximately 4 months earlier showed the same linear foreign body extending from the gastric antrum toward the left hepatic lobe while the adjacent hepatic parenchyma was still normal; the finding had not been reported initially. Laparoscopic drainage yielded approximately 200 mL of pus and enabled intact removal of a 5-cm fish bone, followed by clinical and imaging improvement. This case provides direct serial-imaging evidence of occult transgastric migration preceding hepatic abscess formation. It highlights the importance of reviewing all imaged anatomy, including scan margins, using multiplanar reformations for linear foreign bodies, comparing prior examinations, and identifying and removing a retained foreign body when it is the source of infection.
Related
- Deep Learning Optimizes the Diagnostic Performance of Coronary Computed Tomography Angiography in Heavily Calcified Coronary Plaques: A Chinese Multicenter Study
- Multimodality imaging of lithopedion in a postmenopausal woman: A case report emphasizing the diagnostic role of noncontrast computed tomography.
- Diagnostic accuracy of cone beam computed tomography in the detection of furcation perforations: an in vitro comparison with periapical radiography and micro-computed tomography
- Computed Tomography Features and Diagnostic Pitfalls of Bronchial Chili Pepper Aspiration: Distinctive Morphologies and the False-Negative Peel—A Radiologic–Endoscopic Report of Two Cases
- Diagnostic performance of computed tomography-guided percutaneous bone biopsy in musculoskeletal oncology: A single-center cohort study
BibTeX
@article{liu2026occult,
title = {{Occult transgastric fish-bone migration causing delayed left hepatic abscess: serial computed tomography findings and a missed diagnostic opportunity.}},
author = {Xiu-Xiang Liu and Zhi-Xuan Li and Meng Wu and Ming Tian and Hua Ren},
journal = {BJR case reports},
year = {2026},
month = nov,
doi = {10.1093/bjrcr/uaag041},
url = {https://europepmc.org/article/MED/42997802},
note = {CC BY},
}
RIS
TY - JOUR
TI - Occult transgastric fish-bone migration causing delayed left hepatic abscess: serial computed tomography findings and a missed diagnostic opportunity.
AU - Xiu-Xiang Liu
AU - Zhi-Xuan Li
AU - Meng Wu
AU - Ming Tian
AU - Hua Ren
PY - 2026
DA - 2026/11/02
JO - BJR case reports
DO - 10.1093/bjrcr/uaag041
UR - https://europepmc.org/article/MED/42997802
AB - Ingested fish bones rarely perforate the gastrointestinal tract and migrate into the liver, and the diagnosis may be delayed when ingestion is not recalled and the perforation is locally contained. We report a 45-year-old man who presented with 9 days of intermittent fever, upper abdominal distension, and frequent belching. Ultrasonography demonstrated a large complex collection in the left hepatic lobe with an internal echogenic focus. Non-contrast computed tomography showed a multiloculated left-lobe abscess containing a 5-cm linear hyperattenuating foreign body, focal discontinuity of the gastric antral wall, and hepatogastric inflammatory adhesion. Retrospective review of a chest computed tomography examination performed approximately 4 months earlier showed the same linear foreign body extending from the gastric antrum toward the left hepatic lobe while the adjacent hepatic parenchyma was still normal; the finding had not been reported initially. Laparoscopic drainage yielded approximately 200 mL of pus and enabled intact removal of a 5-cm fish bone, followed by clinical and imaging improvement. This case provides direct serial-imaging evidence of occult transgastric migration preceding hepatic abscess formation. It highlights the importance of reviewing all imaged anatomy, including scan margins, using multiplanar reformations for linear foreign bodies, comparing prior examinations, and identifying and removing a retained foreign body when it is the source of infection.
SN - 2055-7159
ER -