Laparoscopic Removal of a Fish Bone Causing an Abdominal Wall Abscess Using Laparoscopic Ultrasonography: A Case Report.

introductionAbdominal wall abscess caused by gastrointestinal penetration of an ingested fish bone is rare and often difficult to diagnose and manage. We report an educational case highlighting staged management and the practical use of laparoscopic ultrasonography for safe removal of a retained foreign body. CASE PRESENTATION: A 57-year-old Japanese woman presented with recurrent right lower quadrant abdominal pain 1 month after spontaneous resolution of an initial episode. CT revealed inflammatory changes around the transverse colon, a contiguous abdominal wall abscess, and a linear calcified foreign body consistent with a fish bone. Initial conservative treatment with intravenous antibiotics resulted in symptom relief and marked reduction of the abscess; however, the foreign body persisted on follow-up imaging. Elective laparoscopic surgery was therefore performed. Because direct visual identification was difficult due to inflammatory adhesions, laparoscopic ultrasonography was used intraoperatively to localize and safely remove the fish bone without bowel resection. The operative time was 89 min, blood loss was minimal, and the postoperative course was uneventful.

conclusionsStaged management combined with laparoscopic ultrasonography is a useful and minimally invasive approach for treating abdominal wall abscesses caused by ingested foreign bodies when intraoperative visual identification is challenging.