Nagashima Kazunori, Shou Takuya, Haneda Masahira, Nakatsumi Hiroshi, Sasaki Takahide, Sano Itsuki, Izumi Takaaki, Kunieda Yasuyuki
Department of Internal Medicine, Wakkanai City Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2016 Mar;113(3):451-6. doi: 10.11405/nisshoshi.113.451.
A 62-year-old man with right upper abdominal swelling was admitted to our hospital. Abdominal computed tomography (CT) revealed a hepatic abscess. He was treated with percutaneous abscess drainage along with antibiotic therapy. After the treatment, the patient was discharged. However, we failed to notice a fish bone, which had been revealed in the CT scan. One year and five months later, the same patient presented with right lower abdominal pain and vomiting. Abdominal CT showed a subcutaneous abdominal abscess of the right lower abdomen, with the same fish bone penetrating out of the ileum. Accordingly, the patient was subjected to surgical abscess drainage, and the fish bone was successfully removed. The findings of this case suggest that the source of infection of the hepatic abscess should be identified, searching not only the nearby organs but also the distally located organs, including the lower gastrointestinal tract. The findings also suggest that the surgical removal of a fish bone should be considered.
一名62岁右上腹肿胀的男性患者入住我院。腹部计算机断层扫描(CT)显示肝脓肿。他接受了经皮脓肿引流及抗生素治疗。治疗后,患者出院。然而,我们未注意到CT扫描中显示的一根鱼骨。一年零五个月后,该患者出现右下腹痛和呕吐。腹部CT显示右下腹皮下脓肿,同一根鱼骨穿透回肠。因此,患者接受了手术脓肿引流,鱼骨被成功取出。该病例结果提示,肝脓肿的感染源应予以明确,不仅要检查附近器官,还要检查包括下消化道在内的远端器官。结果还提示应考虑手术取出鱼骨。