Inflammatory pseudotumor of liver secondary to migrated fishbone - a rare cause with an unusual presentation
A 35-year-old woman presented to the surgical gastroenterology outpatient department with a short history of vague epigastric pain for one day only. She had no other gastrointestinal symptoms like vomiting or anorexia or weight loss. She had no history of fever or jaundice and no history of similar episodes before, with a normal physical examination. She was referred to us with an ultrasound abdominal scan done in another public hospital, showing a 3×3.5 cm mass in the left lobe of liver. A contrast-enhanced CT scan in our hospital showed an abnormal hypodense lesion with mild enhancement in the arterial phase and with a central calcification (). Complete blood count, liver function test and alpha-fetoprotein were within normal limits.\nA diagnostic laparoscopy was done as a routine protocol in our unit, followed by an exploratory laparotomy, since a definitive diagnosis could not be established. Intraoperatively, a dense fibrotic lesion was felt in the region of liver segments II and III. No peri-hepatic adhesions were seen. Right lobe was normal. A left lateral segmentectomy was done. Dissection of the specimen revealed a 3 cm long fish bone within the fibrotic mass (). There was no purulent material in the lesion. A thorough search for evidence of healed perforation in stomach, duodenum and colon was made and none was found. She had an uneventful post-operative period. The histopathological examination revealed chronic non-specific inflammation with fibrosis consistent with an inflammatory pseudotumor.