A 72-year-old woman presented with a linear hyperdense foreign body that migrated into hepatic segment V, leading to persistent collections that required laparoscopic removal, Cureus reported on Saturday.
Most swallowed sharp foreign bodies pass through the gastrointestinal tract without trouble. However, objects like fish bones can pierce the gut wall and set off localized inflammation or form abscesses, as detailed in the medical literature.
Doctors admitted the patient to the general surgery department for conservative management using intravenous piperacillin-tazobactam. Although her inflammatory markers initially improved, follow-up computed tomography scans showed the perihepatic collections were actually expanding rather than shrinking.
Because percutaneous drainage proved technically unfeasible and serial imaging revealed progressive fluid accumulation, the medical team abandoned antibiotic therapy. Surgeons performed a laparoscopic extraction alongside a cholecystectomy to secure proper exposure of the gallbladder bed.
- Foreign Body Migration: A swallowed sharp object can pierce the digestive tract and travel into nearby organs like the liver without causing immediate, widespread abdominal infection.
- Sealed Perforations: The original hole in the gut can heal itself through local inflammation, meaning surgeons might not spot an active tear during an operation.
- Surgical Intervention: When antibiotic treatments fail to shrink internal fluid pockets and needle drainage is impossible, laparoscopy offers a safe way to remove the object.
Operating room findings revealed dense adhesions of the greater omentum to the gallbladder and the inferior surface of hepatic segment V. Surgeons completed the cholecystectomy to safely expose the gallbladder bed and extract the linear foreign body laparoscopically.
The procedure avoided any need for formal liver resection. Postoperative recovery proceeded without incident, leading to complete clinical resolution and no residual focal lesions on follow-up ultrasonography.
The literature shows that enterohepatic fish bone migration remains an exceptionally rare clinical event. Published literature primarily consists of isolated case reports and small case series rather than large population-based estimates.
Grayson et al. previously identified 52 reported cases of liver abscess secondary to enterohepatic fish bone migration. Chong et al. later reviewed 88 similar cases, while Li et al. evaluated 127 instances of fish bone migration to extraintestinal sites.
Patients who present with right-sided abdominal pain, fever, and nausea—even without any memory of swallowing a bone—require immediate diagnostic evaluation via contrast-enhanced computed tomography. Conservative antibiotic management is strictly contraindicated if imaging shows progressive fluid collections, persistent foreign bodies, or signs of clinical deterioration.
Individuals experiencing acute localized abdominal tenderness, recurring fevers, or signs of peritonitis must seek urgent medical assessment to rule out gastrointestinal perforation and organ-specific complications.
- Figueirôa G, Claro L, Moniz L, et al. Intrahepatic Migration of an Ingested Fish Bone Following Presumed Duodenal Perforation: A Case Report. Cureus. 2026;18(11):e119659. doi:10.7759/cureus.119659
- Grayson et al. Liver abscess secondary to enterohepatic fish bone migration.
- Chong et al. Review of liver abscess secondary to penetration of the alimentary tract by ingested foreign bodies.
- Li et al. Review of fish bone migration to rare extraintestinal sites, including hepatic abscesses.
