A Case of Omental Abscess due to Gastric Penetration by Fish Bone

Tsutomu Namikawa, Seiya Nakamura, Yuji Kondo, Kuniyasu Yamashita, Junichi Miyazaki^* and Keijiro Araki^**

Department of Surgery, ^*Department of Pathology, Kochi Prefectural Seinan Hospital,
^**The First Department of Surgery, Kochi Medical School

A 67-year-old woman was admitted to our hospital in April 1997 with complaint of persistent epigastralgia. On admission, physical examination showed tenderness and rebound tenderness in the upper abdominal region. Blood laboratory data revealed that the white blood cells count was 11,130/mm³, and C-reactive protein was 18.6 mg/dl. Peritoneal free air was not detectable on chest or abdominal roentgenograms. Abdominal ultrasonography revealed a low-echoic lesion with an internal high-echoic region in the upper abdomen. Abdominal CT revealed a low-density area with an internal slender high-density area. An operation was carried out under the tentative diagnosis of peritoneal abscess formation caused by perforation of the gastrointestinal tract. The gastric antrum was edematous and the abscess was found in the greater omentum, so distal gastrectomy was carried out. A fish bone, 4.5 cm in length was found in the omental abscess. Pathohistological examination revealed a cuffed abscess between the submucosal layer and serosa of the gastric antrum to be the site where the fish bone penetrated, and infiltration of neutrophils under the serosa was considered. We report a case of omental abscess due to gastric penetration by a fish bone, although it is definitely uncommon.

Key words
gastric penetration, fish bone, great omental abscess

Reprint requests
Tsutomu Namikawa Department of Surgery, Kochi Prefectural Hata-Kenmin Hospital 3-1 Yoshina, Yamanacho, Sukumo-shi, 787-0785 JAPAN

Accepted
June 22, 1999

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