I made my general surgery residency in the ancient Hospital dos Covões (Coimbra, Portugal). It was a great hospital, full skilled, and loved by patients and professionals. Unfortunately, it was completely changed and destroyed by bad political and administrative decisions. But that is another story…
In 2011, the Surgery Department of Hospital dos Covões (chairman: Prof. Dr. Carlos Costa Almeida) was working full throttle. Either the elective or the emergency surgeries were being performed with great enthusiasm. There was "life" in the Hospital. This new publication of a case report goes back to those times.
A male patient presenting abdominal pain and fever reported to the emergency department. He was diagnosed with a hepatic abscess due to a fishbone. Our first option was a CT guided percutaneous drainage. Since the patient was not getting better, one week later a surgical drainage plus foreign body removal was conducted. This option also failed. Hepatic resection was necessary for sepsis control. In 2011 we performed both the surgical drainage and the atypical hepatic resection by laparotomy. Nowadays, we would choose the laparoscopic approach because of its advantages over open surgery. This case report is the 11th case of hepatic resection due to a foreign body published in the worldwide literature. Although hepatic resection is rarely necessary, all surgeons must be aware of its possibility and be able to perform it. This is one of the take-home messages of this paper. This case report is published in the International Journal of Surgery Case Reports with the title "Hepatic resection due to a fishbone".
The paper presents a review of frequent etiologies of hepatic abscesses, risk factors for foreign body ingestion, how the foreign body gets into the liver, what is the clinical presentation (classic triad), how to treat them, and when to perform hepatic resection.
Because we are general surgeons, this is a paper I believe will be the interest of us all.
Finally, I want to thank Dr. Luis Reis (a great surgeon who treated this patient with me) for all the teaching and companionship during my general surgery residency. He was my mentor during those 6 years of my professional life. He is a true general surgeon, fully skilled in all procedures, with a lot to teach. Hope we can meet again soon.
Link to PubMed:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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