Laparoscopic Removal of a 4-cm Long Fishbone Causing Pyogenic Liver Abscess in an Elderly Patient.

Pyogenic liver abscess secondary to ingestion and migration of a fishbone is extremely rare and poses diagnostic and therapeutic challenges. Early recognition and definitive removal of the foreign body are crucial for successful treatment. An 80-year-old Thai man with diabetes mellitus, hypertension, and chronic kidney disease presented with fever, chills, and dyspnea. Imaging revealed a large multiloculated abscess in the left hepatic lobe containing a linear calcified foreign body consistent with a fishbone. Despite antibiotic therapy and percutaneous drainage, clinical improvement was incomplete. Laparoscopic exploration successfully identified and removed a 4-cm fishbone without the need for hepatic resection. The patient recovered uneventfully, with complete resolution of the abscess on follow-up imaging. Fishbone-induced liver abscess is an uncommon but important differential diagnosis in patients with unexplained hepatic abscesses. Laparoscopic removal provides a safe and effective minimally invasive treatment, even in cases involving relatively long foreign bodies.