A Man Swallowed A Fishbone. This Is What Happened To His Liver.

pb is a 37 year old man presenting to the emergency room with fever chills and abdominal pain he tells the admitting nurse that he woke up overnight in a pool of cold sweat shaking and crying as he could feel aches all over his body his stomach was curling inside of him you see pb was an american professor living in vietnam he was there with his wife and two kids he lived in the city and he took his family on trips all around the region about six weeks ago pb was at a fancy dinner on the menu was norwegian salmon fresh and shipped into vietnam earlier that day ever since he was a kid pb had a habit of not really chewing his food when he ate his mom used to give him a hard time about it when he was in middle school he had dinner at a friend's house friend's mom served canned chicken noodle soup and the boys played basketball afterwards pb didn't feel well during the game and up came the soup with ken carrots fully intact because he didn't chew his food before putting it down after this fancy dinner pb felt great but a few days later he could feel a sharp throbbing pain on his right side these would come and go for about 20 to 30 minutes at a time but then they'd go away this lasted for a few days before pb started developing a fever he started shaking in the middle of the night because even though he felt chilly his body temperature was hot and his sweat was cold he took some ibuprofen hoping it would help with the pain and his fever but it didn't do anything at physical exam in the emergency room doctors didn't find anything wrong even a blood test returned normal pb had gotten his appropriate travel vaccinations americans can have exposure to pathogens in southeast asia or really any continent for that matter these are things that just aren't endemic to north america everything he needed to do for his health he did but an ultrasound on his abdomen suggested hepato splenomegaly hepato referring to the liver spleno referring to the spleen which is an organ that recycles old red blood cells and stores white blood cells that's connected to the liver and megaly from mega indicating an enlarged size a possible enlargement of the liver and the spleen ultrasound won't show you everything it's sound waves bouncing around giving an idea of shapes and sizes of things but its suggestions tell doctors if more imaging is needed and in pb more images were needed all of this happening with a fever that wasn't improving with repeat doses of tylenol and ibuprofen as the days go by those additional images of pb's abdomen were taken all of them were still suggesting hepatosplenomegaly but it was still borderline they could be enlarged but not out of the realm of being a little bit bigger than average one of pb's friends was a prominent doctor in vietnam i love my country but i think it's time for you to leave he said thinking that adequate resources for his case may not be available at this community level hospital as an american professor pb had academic medical colleagues at big institutions they recommended him for transfer to a larger hospital in thailand one with international accreditation as pb was flown in by helicopter his case was still unclear he had a fever that wasn't responding to medicines but his sinuses and lungs were clear so no respiratory infection his urine was clear so no urinary tract infection his stool was free of parasites so there was no infection there either a ct scan at this international hospital did confirm pb had hepatosplenomegaly but that wasn't his only problem doctors found what looked like a liver cyst one centimeter in diameter doctors collected blood from pb to culture and grow to find out if bacteria was floating around in his body because no matter what everything points to some kind of infection happening somewhere but these cultures will take some time to grow as the days go by doctors at the international hospital keep looking to see what's wrong but they couldn't find anything pb's body temperature kept increasing doctors kept asking pb if he had any recollection of ingesting some kind of medicine or some kind of food that may have been out of his normal routine but he couldn't remember anything that could have been a problem on day four of hospitalization one of the blood cultures returned bacteria that's normally found in the human mouth named streptococcus constellatus was found growing in that culture meaning that was the bacteria that was floating around in his blood causing his fever but if it's normally found in the mouth how did it get into his bloodstream and what would it have to do with any kind of suspicious fish dinner antibiotics were started over the next two days pb started feeling better his fever completely resolved repeat blood tests returned normal and repeat blood cultures were clear no more bacteremia or bacterial presence in blood everything seemed to be going well doctors were getting ready for pb's discharge from the hospital except the doctor in america asked for more tests she wasn't convinced that pb was fine because even if the bacteria is cleared from the blood now it doesn't mean that it won't come back antibiotics can kill the bacteria temporarily but different bacteria can mean different things and when streptococcus constellatus shows up in the blood doctors need to find an abscess or a bag of pus that's formed somewhere in the body because this bacteria specifically can spread and form new abscesses in other organs it might have already started spreading around in his body whatever was on his liver isn't good but it might not be his only problem on this request doctors at the international hospital do repeat scans of pb's abdomen images show that he still has hepatosplenomegaly but now lymph nodes in his abdomen are swollen when they weren't before multiple lesions were found on his liver that weren't there before parts of his pancreas were now swollen when they weren't before and the vein that feeds from the small intestines into the liver now had a blood clot formed inside of it meaning that even if the bacteremia isn't detectable by the lab that bacteria could still be hanging around somewhere and spreading doctors at the international hospital were confused by what was happening they looked over the scans and how the images changed over time they had been looking at them for days pb's dad was with him at the hospital in thailand he was a doctor himself too the surgeon working on pb's case flagged dad down and said hey look at this it really looks like there's some kind of fish bone in his pancreas the dad looked at the surgeon and said that's ridiculous the chances of that happening are slim to none and i've never seen it in my practice there's no way as the images were transmitted to american doctors pb was transferred out of the international hospital and then back to the u.s as he arrived at his colleagues hospital on admission to the american hospital doctors immediately started looking for an abscess despite the scans in vietnam and thailand suggesting a cyst on his liver the problem now is that the bacteria that was found in his blood could have already spread to other organs it could be on his lungs it could be on his kidneys and it could be on his brain the lesions found on his liver could be the source of all of pb's problems but something's wrong usually liver abscess like this also means some kind of underlying disease it's just not common that you're going to grow a big zit on your liver but pb had no past medical history there usually isn't any kind of known pathogen in fresh salmon that could have caused these problems either his pancreas was inflamed so that could be it but his pancreas was fine earlier in the vietnam hospital and it only entered the picture after his bacteremia was cleared a bacteria known as klebsiella pneumoniae can cause a liver abscess and this is well documented to happen in asia but it's something that often appears before someone gets diagnosed with colon cancer and knowing that colon cancer patients have been getting younger over the years affecting people in their 30s now rather than people in their 50s and above pb at 37 years old living in asia could be at risk all of these are reasons why the american doctors transferred him back to the states but there's more pb had a blood clot in the vein leading up to his liver when someone has cancer their blood can be in a hyper coagulable state meaning more clots can form compared to normal but an infection can cause the same clot in the same vein too meaning no matter what surgeons need to open him up and take a look at what's happening before he was sent in for surgeries doctors took another look at all of the images taken of pb since he was hospitalized in the early images a foreign body was found in the part of his small intestines where it connects to the stomach called the duodenum doctors had to know what they were looking for to find it in those early images but the later images show this same body migrating from the duodenum as it keeps moving throughout the days it finally pierced his intestines and lodged itself into the head of his pancreas whatever this foreign body was it traversed the superior mesenteric vein causing that blood clot and because it punctured a hole in his intestines this might be what have caused his bacteremia specifically that would be bacteria that's found in his mouth this object looked like it could have been a toothpick or a needle or as the thai doctor said to pb's dad a fish bone as surgeons open up pb to explore they found marked inflammation by his pancreas leading them directly to the object they placed metal clips on each end and extracted it after cutting it in half and there they saw a fishbone sharp and brittle as they sewed him back up and sent him into the recovery room fishbone ingestion isn't really that uncommon they're usually smaller than chicken and pork bones and when they do get lodged in the body it's usually right after the mouth right by the tonsils if it doesn't happen in children because they're young and they don't know it could be because someone is elderly and they have dentures or if it is a middle-aged person it could be because they're drunk or they don't chew their food well before swallowing usually they get passed without any problem but if they do perforate something usually that happens in the intestines and those cases have been reported in literature for at least 100 years now bringing us back to pb looking back on it he realized that his mom had a point when she always gave him trouble for not chewing his food well after he woke up from surgery he remembered the exact dinner where he thought he might have swallowed a fish bone he thought he bit something tough but didn't feel anything on the way down at the time he didn't even think twice about it his illness spanned three countries there was suspicion of colorectal cancer because of the abscess on his liver the bacteria found in his blood and because of the region where he was living everything put together indicated a possibility of colorectal cancer but thai doctors were right there was actually a fish bone lodged in his pancreas that broke his intestines causing the liver abscess causing bacteremia fever and abdominal pain and thrombosis of the superior mesenteric vein that all would have probably gotten worse had this bone not been found and removed and as he was discharged from the hospital in america pb returned to vietnam to move back stateside as he made a full recovery take care of yourself chew your food well and be well

Channel: Chubbyemu

Views: 1,090,446

Rating: 4.9643488 out of 5

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Id: W9AqI_uhttk

Length: 11min 10sec (670 seconds)

Published: Sun Aug 30 2020