A Case of Mesenteric Abscess Caused by an Ingested Fish Bone that Penetrated the Duodenum
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We experienced a case of mesenteric abscess caused by an ingested fish bone that appeared to havepenetrated the third portion of the duodenum. A 48-year-old male with a 4-month history of repeatedabdominal pains visited our clinic because of increasing pain and a fever. The patient's body temperaturewas 39.5°C. On physical examination, a tender and firm mass was palpable around the umbilicus.Ultrasonography and computed tomography (CT) showed a cystic lesion containing a bone-like linearshadow contiguous with the third portion of the duodenum. When the patient's history was taken, hementioned that he had eaten sea bream. Therefere, a penetration of the duodenum caused by the fish boneand the formation of an abcess in the mesentery was suspected. Since the administration of antibiotics forone week did not improve his symptoms, surgery was performed. Intraoperatively, a hen's egg-sized masswas found in the proximal mesentery, with its superior margin contiguous with the third portion of theduodenum. To avoid injury of the superior mesenteric artery and vein, the abscess was opened and a fishbone, 2cm in length, was removed from the cavity under ultrasonographic guidance. The abscess cavity wasrinsed with saline, and a drainage tube was inserted. Postoperatively, the patient's general conditionpromptly improved, and he was discharged from hospital on the 12th postoperative day. Only ten cases, including the present case, of duodenal penetration by a fish bone have been reported in Japanese medicalliterature. These rare cases are reviewed.
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日本腹部救急医学会 | 論文
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