Delayed Formation of a Liver Abscess Caused by a Penetrating Metal Foreign Body from the Duodenum

Abstract

An 18-year-old man was admitted to our hospital complaining of epigastric pain. He gave a history of having voluntarily swallowed a metal piece 3 months earlier. Abdominal examination revealed no rebound tenderness or guarding of the abdomen. Laboratory data showed elevated levels of inflammation markers. Abdominal computed tomography revealed the long linear metal piece penetrating through the duodenum into the right lobe of the liver and a large liver abscess measuring 65 mm in diameter. Percutaneous transhepatic abscess drainage（PTAD）was immediately performed. Subsequently, 4 days after the PTAD, surgery was performed to remove the metal piece measuring 106 mm in length from the duodenum. A long linear thin piece, similar to a fish bone and/or a toothpick, caused delayed liver abscess formation following secondary penetration of the liver from the gastrointestinal tract. This is among the first reports of formation of a liver abscess 3 months after penetration of the liver by a swallowed metal piece from the duodenum.