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An Unusual Cause of Anterior Abdominal Wall Abscess. Left Anterior Abdominal Wall Abscess Secondary to Fish Bone Migration from the Gastrointestinal Tract.

Question: A 71-year-old woman, who had no previous psychiatric history or abdominal surgery, was admitted to the hospital for left hypochondrial mass for 2 weeks, associated with an ache over the area and loss of appetite for the same duration. No fever was experienced. She was also noted to move her bowels every 2–3 days (previously daily) for the past 2 weeks. Physical examination revealed a 7-cm, immobile, firm mass about 6 cm below the left subcostal margin with normal overlying skin. Digital rectal examination was unremarkable. Initial abnormal laboratory tests were as follows: hemoglobin, 11.0g/dL; white blood cell count, 11.6 10/L; and sodium, 127 mmol/L. Supine and erect abdominal radiographs showed gaseous distension of the large bowel (Figure A). CT of the abdomen and pelvis was done (Figure B, C). What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.