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Liver abscess secondary to a broken needle migration--a case report.

- BMC Surg (2003)

Bottom Line: Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver.A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented.The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery and Radiology, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi-110023, India. chintamani7@rediffmail.com

ABSTRACT

Background: Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain.

Case report: A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery.

Conclusion: It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.

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Abdominal x-ray (AP view) showing the needle in the region of the liver
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Figure 1: Abdominal x-ray (AP view) showing the needle in the region of the liver

Mentions: A 26 year old gentleman presented to the surgical wing with pain right upper abdomen and intermittent high grade fever with chills and rigors along with vomiting off and on for the last one year. There was no history of jaundice or urinary complaints. He had received treatment for his fever as a case of pyrexia of unknown origin at a remote district hospital in the form of antibiotics, antimalarial drugs and antipyretics with symptomatic relief after each episode. He was referred in view of the recurring and persisting symptoms and lack of facilities for ultrasound and other advanced investigations. Examination revealed a pale, febrile (temp:102*f) and toxic patient with tachycardia (pulse 110/mt), tachypnoea(R/R :20/mt). Abdomen was tense with tenderness in the right hypochondrium without any signs of peritoneal irritation. Liver was enlarged and tender. Blood chemistry was by and large within normal limits except for anaemia(Hb:9 gm%) and leucocytosis (Total count; 13000/cumm, polymorphs: 80%). Liver function tests were within normal limits except serum alkaline phosphatase which was raised, serum bilirubin and urine examination were normal. X-ray abdomen revealed a foreign body (? needle: fig 1) in the region of the liver. Ultrasound examination of the abdomen (fig 2) and contrast enhanced computed tomography scan(fig 3) confirmed the presence of a needle in the right lobe of the liver along with an abscess of the size 6.5 × 6 × 4 cm in the segment V(according to the Couinaud's nomenclature of liver segments). Patient was started on 3rd generation cephalosporins(Cefotaxime), Metronidazole and subjected to exploratory laparotomy which revealed multiple adhesions in the region of segment V of the liver with omentum and duodenum however no obvious fistulous communication between the biliary system and the stomach or duodenum could be appreciated. There was an abscess of the size of 6.5 × 6 × 4 cm in the segment V (five), about 200 cc of pus was drained and a broken sewing needle of the size 3 cm(fig 4) was retrieved. After a thorough peritoneal lavage using normal saline and packing the cavity with omentum, abdomen was closed leaving a tube drain in situ. Antibiotics were revised based on the subsequent culture sensitivity report that showed Sretptococcus pyogenes and E. Coli. Postoperative recovery was good and one year follow up reveals a satisfactory outcome. It could be suspected that an accidentally ingested broken sewing needle made its way in to the right lobe of the liver after penetration of the duodenum or stomach as was evident at laparotomy in the form of adhesions between the stomach, duodenum and omentum with the right lobe of liver.


Liver abscess secondary to a broken needle migration--a case report.

- BMC Surg (2003)

Abdominal x-ray (AP view) showing the needle in the region of the liver
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC239862&req=5

Figure 1: Abdominal x-ray (AP view) showing the needle in the region of the liver
Mentions: A 26 year old gentleman presented to the surgical wing with pain right upper abdomen and intermittent high grade fever with chills and rigors along with vomiting off and on for the last one year. There was no history of jaundice or urinary complaints. He had received treatment for his fever as a case of pyrexia of unknown origin at a remote district hospital in the form of antibiotics, antimalarial drugs and antipyretics with symptomatic relief after each episode. He was referred in view of the recurring and persisting symptoms and lack of facilities for ultrasound and other advanced investigations. Examination revealed a pale, febrile (temp:102*f) and toxic patient with tachycardia (pulse 110/mt), tachypnoea(R/R :20/mt). Abdomen was tense with tenderness in the right hypochondrium without any signs of peritoneal irritation. Liver was enlarged and tender. Blood chemistry was by and large within normal limits except for anaemia(Hb:9 gm%) and leucocytosis (Total count; 13000/cumm, polymorphs: 80%). Liver function tests were within normal limits except serum alkaline phosphatase which was raised, serum bilirubin and urine examination were normal. X-ray abdomen revealed a foreign body (? needle: fig 1) in the region of the liver. Ultrasound examination of the abdomen (fig 2) and contrast enhanced computed tomography scan(fig 3) confirmed the presence of a needle in the right lobe of the liver along with an abscess of the size 6.5 × 6 × 4 cm in the segment V(according to the Couinaud's nomenclature of liver segments). Patient was started on 3rd generation cephalosporins(Cefotaxime), Metronidazole and subjected to exploratory laparotomy which revealed multiple adhesions in the region of segment V of the liver with omentum and duodenum however no obvious fistulous communication between the biliary system and the stomach or duodenum could be appreciated. There was an abscess of the size of 6.5 × 6 × 4 cm in the segment V (five), about 200 cc of pus was drained and a broken sewing needle of the size 3 cm(fig 4) was retrieved. After a thorough peritoneal lavage using normal saline and packing the cavity with omentum, abdomen was closed leaving a tube drain in situ. Antibiotics were revised based on the subsequent culture sensitivity report that showed Sretptococcus pyogenes and E. Coli. Postoperative recovery was good and one year follow up reveals a satisfactory outcome. It could be suspected that an accidentally ingested broken sewing needle made its way in to the right lobe of the liver after penetration of the duodenum or stomach as was evident at laparotomy in the form of adhesions between the stomach, duodenum and omentum with the right lobe of liver.

Bottom Line: Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver.A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented.The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery and Radiology, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi-110023, India. chintamani7@rediffmail.com

ABSTRACT

Background: Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain.

Case report: A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery.

Conclusion: It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.

Show MeSH
Related in: MedlinePlus