A Case of Abdominal Wall Abscess Caused by Occult Gastrointestinal Perforation due to a Fish Bone Treated Laparoscopically

Abstract

A 77-year-old man presented with left-sided abdominal pain lasting for one month. Examination revealed a mass with warmth and tenderness in the left side abdomen. Blood tests showed elevated inflammatory markers, and a contrast-enhanced CT scan revealed a ring-enhancing mass suggesting an abscess and a linear hyperdense area indicative of a fish bone. He was diagnosed with an abdominal wall abscess caused by a foreign body which was inferred to be a fish bone, and diagnostic laparoscopy was planned. Laparoscopic surgery involved drainage of the abscess cavity and removal of the fish bone ; however, no intestinal perforation site could be identified. The patient was discharged on postoperative day 4 and has shown no recurrence to date. Fish bones are a common cause of foreign body ingestion in Japan due to dietary habits, but cases of abdominal wall abscess with an unclear perforation site are rare. While a good outcome was achieved with laparoscopy in this case, reports exist of retained fish bones after such procedures, emphasizing the need to carefully evaluate the appropriateness of laparoscopic surgery preoperatively.