Female patient NTT, 82 years old, was brought to the hospital by her family because of abdominal pain that lasted for many days, getting worse and worse, accompanied by fever and fatigue. Doctors from the General Surgery Department, An Binh Hospital (HCMC) conducted a clinical examination and noted pain in the epigastric region, typical pain and resistance to palpation of peritonitis. The patient was given a blood test and abdominal ultrasound. The results showed an increase in white blood cells, a sign of infection; abdominal ultrasound showed a fluid collection in the epigastric region.
The fish bone after being removed
From there, the doctor ordered a computed tomography (CT) scan, the image showed a large abscess, about 10 cm in the left liver, below was a small abscess next to the stomach, and between the liver and stomach was a piece of fish bone about 4 cm long. With the CT results, along with the condition of peritonitis, Mr. T. was immediately scheduled for surgery.
Dr. Tran Duc Loi, Department of General Surgery - An Binh Hospital, said: "We performed laparoscopic surgery on the patient. Mr. T's left liver was swollen, with a large abscess. When we broke it, we were able to drain about 300 ml of pus. After draining all the pus from the liver, we approached the small abscess between the liver and the stomach. When we broke it, we found the fish bone to remove it. The patient no longer had a hole in the stomach, because the fish bone was sharp and small. After it fell out, the small hole in the stomach closed itself. The doctors cleaned the abdominal cavity and drained it."
One day after the surgery, Mr. T. was awake and had much less abdominal pain. By the morning of May 13, 4 days after the surgery, the patient's condition was stable, he could eat and drink normally, walk, the surgical wound still had slight pain, and it was expected that he would be discharged in 2 days.
One day after surgery, Mr. T.'s pain was much reduced and his health was stable.
It is worth noting that the fish bone was completely outside the stomach, the bone fragment penetrated and fell out, piercing the liver causing a large abscess. This is a rare case because normally in cases of foreign bodies in the digestive tract, if the foreign body punctures, only the sharp part will come out, the rest will remain inside. For example, a patient accidentally swallowed a toothpick, the toothpick went down to the small intestine, punctured the small intestine, then only the sharp end protruded out, the body of the toothpick remained in the intestine.
Dr. Tran Duc Loi noted: "Neither Mr. T. nor his family knew that he had mistakenly swallowed a fish bone. Only when the doctor looked at the CT scan image and asked again did he confirm. The reason is that Mr. T. is old, has few teeth and weak teeth, so when chewing, he did not realize that there were bones left in other food, and just swallowed it. Therefore, families with elderly people should pay attention to removing the bones first when eating fish."
According to Dr. Loi, in cases of prolonged abdominal pain without a clear cause, you should go to a medical facility soon to see a doctor. Without a doctor's prescription, you should absolutely not take antibiotics or painkillers on your own because it will obscure the symptoms of the disease, while the disease continues to progress, and thus may lead to a delay in bringing the patient to the hospital. As in the case of Mr. T., if he had been hospitalized later, the large abscess in the liver would have been at risk of rupturing, causing a very serious blood infection and making treatment extremely complicated.
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