A Case of Omental Abscess due to a Silent Fish Bone Perforation

Kazuhito Yamamoto, Hiroyuki Kiuchi, Yoshio Ogawa, Susumu Yamamura, Yoshiyuki Takahashi, Atsushi Sugiura, Tetsuya Okino¹⁾, Hiroshi Yoshida²⁾ and Takashi Tajiri²⁾

Department of Surgery Kitamurayama Public Hospital
Department of Gastroenterology Kitamurayama Public Hospital¹⁾
First Department of Surgery, Nippon Medical School²⁾

A 76-year-old man admitted for lower acute abdominal pain showed signs of peritonitis irritation in the lower abdomen on admission. Blood laboratory data showed a C-reactive protein count of 5.0 mg/dl. Endoscopy showed no abnormal findings. Ultrasonography and computed tomography showed a mildly enhanced 3.5 cm mass suggesting inflammation of the fat tissue. We could not make a definitive diagnosis and conducted surgical resection under a tentative diagnosis of peritonitis due to perforation. At laparotomy, we found an abscess in the greater omentum 3×3.5 cm in diameter, free from other organs. The ruptured abscess had caused panperitonitis. There was no evidence of perforation in the gastric or intestinal wall, and no other intraabdominal abnormalities were found. We resected the mass and drained the abdominal cavity. Streptococcus intermedium was isolated from pus from the abscess. Microscopically, segmented spicules suspected of being of fish bone origin appeared in the omental abscess. Such a case of omental abscess due to perforation by a fish bone is very uncommon.

Key words
peritonitis, omental abscess, fish bone

Reprint requests
Kazuhito Yamamoto First Department of Surgery, Nippon Medical School
1-1-5 Sendagi, Bunnkyou-ku, Tokyo, 113-8603 JAPAN

Accepted
April 28, 2004

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