Two Cases of Intraabdominal and Anterior Abdominal Wall Abscesses from Fish Bone Bowel Perforations

Fish bone bowel perforation has been shown as a major cause of presentation in the emergency room, even though most dietary foreign bodies are passed unnoticed. This a case report of a couple of patients who presented at the emergency room with acute abdominal pain. Both patients had no memory of recently swallowing any fish bone. Case 1 showed moderate right upper quadrant tenderness and hepatomegaly, while case 2 had paraumbilical tenderness and guarding. On CT imaging both patients demonstrated intraabdominal abscesses: in the liver for case 1, and intraperitoneal and anterior abdominal wall for case 2. Linear hyperdense structure of calcific density (HU 93-151) was seen in each intraabdominal abscess collection, and an abutting adjacent bowel loop. These imaging findings were confirmed during surgical intervention: laparoscopic hepatic abscess drainage and laparotomy/anterior abdominal wall repair respectively for case 1 and case 2.