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Chinese Journal of Hepatic Surgery(Electronic Edition) ›› 2021, Vol. 10 ›› Issue (04): 418-422. doi: 10.3877/cma.j.issn.2095-3232.2021.04.017

• Clinical Research • Previous Articles     Next Articles

Misdiagnosis of inflammatory pseudotumor of liver caused by fishbone: one case report and literature review

Baoding Zhuang1, Maimaitireyimu Musitaba·2, Yi Lu1, Yanjie Li1, Rishun Su1, Meihai Deng1, Jianliang Xu1,()   

  1. 1. Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of General Surgery, the First People's Hospital of Kashgar, Kashgar 844000, China
  • Received:2021-04-28 Online:2021-08-18 Published:2021-09-08
  • Contact: Jianliang Xu

Abstract:

Objective

To explore the diagnostic and treatment characteristics of inflammatory pseudotumor (IPT) of the liver caused by fishbone.

Methods

Clinical data of 1 patient with IPT of the liver caused by fishbone admitted to the Third Affiliated Hospital of Sun Yat-sen University in August 2015 were retrospectively analyzed. The male patient aged 51 years. The informed consent of the patient was obtained and the local ethical committee approval was received. The clinicopathological data of relevant literature were reviewed and analyzed including medical history, diagnosis and treatment, clinical prognosis and follow-up. The diagnostic and treatment characteristics of this rare case were summarized.

Results

The patient was hospitalized due to "recurrent right upper abdominal pain for more than 3 years, which was aggravated complicated with anorexia for 1 month". Laboratory examination upon admission indicated that WBC, GGT, C-reactive protein and erythrocyte sedimentation rate were increased. The possibility of intrahepatic cholangiocarcinoma could not be excluded by abdominal ultrasound, CT scan and MRI. The intrahepatic tumor was diagnosed as an inflammatory lesion by ultrasound-guided percutaneous liver biopsy. After anti-infection treatment, the liver mass was not significantly reduced, and clinical symptoms still recurred. On December 15, 2015, abdominal exploration was performed on the patient and a fishbone was found invaded into the left liver lobe from the antrum. Thus partial hepatectomy was conducted, the fishbone was removed, cholecystectomy was carried out, followed by extensive adhesion management and gastric wall perforation repair. The diagnosis of IPT of the liver was confirmed by postoperative pathological examination. At 1 month after discharge, the patient was generally in good condition, and all the laboratory test results were normal. Abdominal enhanced CT scan showed no residual lesion at the surgical site.

Conclusions

IPT of the liver caused by foreign matter, such as fishbone, is a rare space-occupying intrahepatic lesion, which is likely to be misdiagnosed as tumors by the imaging examination. Pathological biopsy plays a pivotal role in the diagnosis of IPT. Surgical removal of foreign matter and repair of perforated digestive tract are effective therapies.

Key words: Granuloma, plasma cell, Liver, Intrahepatic cholangiocarcinoma

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