A Case of an Omental Abscess Caused by Perforation of the Digestive Tract with a Fish Bone Treated with Single-incision Laparoscopic Surgery

Abstract

An 80-year-old woman presented for examination in our department complaining of left lower abdominal pain that had persisted for approximately 1 month. Localized tenderness and muscular guarding of the left lower abdomen were present. Abdominal contrast-enhanced computed tomography (CT) revealed a 5-cm mass constituting a suspected abscess, together with a 4-cm-long linear hyperdensity in the greater omentum adjacent to the transverse colon. The patient had accidentally swallowed a salmon bone a few days before the lower abdominal pain appeared；therefore, peritoneal abscess due to perforation of the digestive tract with a fish bone was diagnosed, and surgery was performed. An omental mass adjacent to the transverse colon was removed by single-incision laparoscopy. The transverse colon serosa around the mass was reddened with some erosion, but no obvious perforation site was identified. Although there have been a few reported cases of peritoneal abscesses caused by fish bones in which the perforation or penetration site was unclear, the site can be roughly identified on preoperative CT. Single-incision laparoscopic surgery, which has been increasing in popularity in recent years, may therefore provide one option for treatment.