A 51-year-old female patient with diabetes visited the Hepatobiliary Surgery Department of our hospital to address a persistence of chills and fever that had lasted for over 2 wk. The patient reported that her symptoms had started 15 d prior to presentation, with her highest recorded body temperature during that time reaching 38.8 °C. She had visited another local hospital and had been given anti-infection treatment, which had not resolved the symptoms. The repeat fever prompted her to visit our hospital. The patient had been diagnosed with diabetes 1 year prior but was not monitoring her glucose levels. She also had a history of appendectomy and no known drug allergies. She denied any history of hypertension or coronary heart disease. She recalled no experience of physical discomfort. She has not had physical examinations for an extended period of time. The patient denied any relevant family history. Evaluation of the vital signs showed blood pressure of 115/71 mmHg, heart rate of 90 beats per min, temperature of 36.7 °C, and respiratory rate of 18 breaths per min. The height was 160 cm and weight was 65 kg (being classified by body mass index as ‘slightly overweight’). Physical examination showed a slight tenderness under the xiphoid process and upper abdomen. No palpable lymphadenopathy or mass was found. There were no remarkable findings with respect to other clinical signs (e.g., McBurney's point tenderness, rebound tenderness and muscle tension, and abnormalities of the cardio-pulmonary system). After being admitted, the patient underwent laboratory examinations including routine blood test, stool analysis with fecal occult blood test, liver and kidney function tests, electrolyte panel, blood coagulation factor tests, and tumor markers tests. Endoscopy and the preoperative examinations eliminated the possibility of syphilis, hepatitis B, hepatitis C, and human immunodeficiency virus infection. Routine blood test showed elevated leukocytes (24.67 × 109/L; normal range: 4.00-10.00 × 109/L) and neutrophils (91.24%; normal range: 50%-70%). The biochemical tests showed decreased albumin (28.2 g/L; normal range: 35.0-54.0 g/L) and increased alanine aminotransferase (84 IU/L; normal range: 0-40 IU/L), aspartate aminotransferase (67 IU/L; normal range: 0-46 IU/L), and D-dimer (14.68 mg/mL; normal range: 0-0.50 mg/mL). The tumor markers carcinoembryonic antigen (CEA) (0.8 ng/mL; normal range: 0-5.0 ng/mL) and CA199 (5.45 U/mL; normal range: 0-40 U/mL) were within the normal range. There was no remarkable finding obtained from any of the other hematologic tests. Plain computed tomography (CT) scanning of the liver and gallbladder, performed in another hospital, had displayed a low-density mass in the patient’s hepatic porta, and the possibility of malignant tumor cannot be ruled out. We augmented the imaging examination by performing color Doppler ultrasound of the liver and gallbladder, and found a hypoechogenic mass in the caudate lobe of the liver (6.5 cm × 4.3 cm in size) which was suspected as a malignant tumor. Plain plus enhanced magnetic resonance imaging of the liver and gallbladder also showed a space-occupying lesion on the caudate lobe of the liver (7.6 cm × 4.4 cm × 5.0 cm), which was suspected as cystadenocarcinoma and was considered in differential diagnosis (from hepatic abscess) along with the patient’s clinical manifestations. A new plain CT scan of the liver, gallbladder, and spleen suggested a foreign body (fishbone) in the upper abdomen, which had perforated the gastric wall and reached the hepatic hila, and consequent abscess formation in the caudate lobe and superior head of the pancreas (7.8 cm × 6.0 cm × 5.0 cm). Gastroscopy was ordered and revealed chronic gastritis and a sinus tract located in the anterior wall of the duodenal bulb.