Parenchymal Injury Caused by Complete Migration of a Bone of Japanese Horse Mackerel Within the Pancreatic Uncinate Process Through a Duodenal Diverticulum, Resulting in Sepsis and Multiple Pyogenic Liver Abscesses.

BACKGROUND An ingested fish bone may cause bowel penetration and subsequent infection, and approximately 1% of such cases require emergent surgery. Moreover, infection and hemorrhage may occur when a penetrated fish bone migrates into surrounding organs or vessels. CASE REPORT A 79-year-old man ate grilled Japanese horse mackerel. Three days later, he developed abdominal pain and a sustained fever. Computed tomography detected a fully migrated scad bone embedded in the pancreatic uncus through a duodenal diverticulum, along with multiple pyogenic liver abscesses. Intravenous broad-spectrum antibiotic therapy was started for sepsis. Endoscopic removal was attempted but failed. Surgical removal was proposed, and the pancreas and duodenum were mobilized. Intraoperative ultrasonography revealed that the fully migrated scad bone had been removed from the pancreatic parenchyma and broken into 2 fragments during the surgical procedure. The 2 fragments were located in the third portion of the duodenum and the diverticular cavity, respectively. One fragment in the third portion was successfully removed by an intraoperative endoscopic maneuver. Postoperative endoscopic examination and imaging demonstrated that the other fragment in the diverticular cavity had passed spontaneously by bowel peristalsis. Intravenous antibiotic therapy with appropriate de-escalation was continued for 14 days. The multiple pyogenic liver abscesses disappeared, and the patient recovered from sepsis. CONCLUSIONS Pyogenic liver abscess caused by hematogenous spread is a serious infectious disease, and sepsis may be fatal. A migrated fish bone within an adjacent organ should be removed as soon as practicable because this retained foreign body may subsequently cause severe infectious complications.