Liver abscess due to sewing needle perforation.
A 45-year-old female was admitted to the hospital with a 1-week history of right upper abdominal pain and nausea. Ultrasonography showed a thickened duodenum with infiltration. Subsequent gastroscopy did not reveal any abnormalities. CT scan showed a foreign body perforation at the duodenum and a liver abscess (Fig. 1A,B). A diagnostic laparoscopy was performed. During the operation, the abscess was drained (Fig. 2A,B) and a sewing needle was removed (Fig. 3A,B). The patient claimed to have no recollection of swallowing the needle and made a quick recovery. Although rare, gastrointestinal perforations due to ingested foreign bodies most frequently occur at ileocecal, rectosigmoid, and duodenal regions[1]. Sewing needle perforations into the liver have been reported in children, adults, and psychiatric cases. Symptoms can vary from mild gastric pain to signs of peritonitis[2]. "Wait and see" is recommended for asymptomatic patients with no complications. Symptomatic patients (e.g., liver abscess) need surgical intervention[1,2,3].
Jutte
Ewoud
E
Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. ejutte@rkz.nl
Cense
Huib
H
D015746:Abdominal Pain / Q000209:etiology; D003679:Deglutition; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009339:Needles; D014463:Ultrasonography