Recurrent liver abscess

Clinical scenario: A 48 yr old male  presented with h/o Fever and abdominal pain of 10 days duration  On examination he was conscious oriented  and had stable vitals, temp 38° C ,he had mild hepatomegaly, rest of clinical examination was unremarkable  Investigation: WBC 12,0000  Liver function test normal

      An ultrasound revealed  Liver abscess . The patient was given  Antibiotics and the abscess was drained. He became afebrile and was discharged home Symptoms recurred after 1 month and he was admitted again.

2nd admission : He had high-grade fever and labs showed WBC count of 16000. Liver function tests showed normal Bilirubin, elevated alkaline phosphatase.CT scan abdomen was done which showed the presence of a foreign body in the liver and residual liver abscess (Fig 1). The patient was operated and the foreign body was removed which proved to be fishbone  (Fig 2) Patient became afebrile after surgery.

Fig 1 CT scan showing foreign body in Liver and residual abscess 

 

Fig 2 2.5 cms long fish bone removed on surgery 

       On repeated questioning patient admitted intake of   Fish in a restaurant 5 months prior to the clinical presentation but he had forgotten the episode and didn't link his fever to that episode. Endoscopy(Fig 3) was done to see where from fishbone had migrated to the liver , it showed a healed scar in duodenum the possible site of the migration to the liver  

Fig 3 Endoscopy showing healed scar in Duodenum Possible site of migration from gut to liver 

  Foreign bodies move in the gut due to peristalsis.