A case report of chronic abdominal pain caused by non digestive or psychological disorders

Abstract

Background

Chronic abdominal pain (CAP) is defined as ongoing or recurring abdominal pain that lasts for three months or longer, presenting a complex medical challenge due to its wide range of possible causes. Here, we report a case of CAP caused by a non-digestive and non-psychological disorder.

Case presentation

A 49-year-old man began experiencing intermittent upper abdominal pain three months ago. Gastroenteroscopy revealed chronic non-atrophic gastritis with erosion and multiple colon polyps. He received treatment including proton pump inhibitors (PPIs), Chinese medicine, painkillers, and psychological therapy, but his symptoms did not improve. One day ago, his abdominal pain worsened along with fever of 38.5 °C. Computed tomography (CT) scan showed a foreign body (FB) and pneumoperitoneum. Urgent laparoscopic exploration was performed, revealing a 3.5 cm fishbone penetrating the left lobe of the liver. The fishbone was successfully removed, and his abdominal pain finally disappeared.

Conclusion

CAP is a complex condition with significant diagnostic challenges. Hepatic foreign bodies are very rare and are frequently overlooked in gastroenteroscopic evaluations, which can lead to delayed diagnoses. CT scanning is a crucial diagnostic tool for identifying FBs. Laparoscopic minimally invasive extraction is a viable option for FB removal when indicated. This case underscores the necessity of addressing both physical and psychological factors when managing CAP.