Liver abscess caused by toothpick and treated by laparoscopic left hepatic resection: case report and literature review

Abstract

SummaryHepatic abscesses caused by ingested foreign bodies have been reported in the medical literature but represent very uncommon events. Extra-luminal migration of sawing needles and pins is the most common cause of perforation of the gastrointestinal tract associated with liver infections. Other non-metallic sharp objects such as animal bones and toothpicks have been described but are less frequent. The authors present a case of a 45-year-old woman who suffered from sepsis and a liver abscess because of the migration of a toothpick that lodged in the left hepatic lobe. Review of the literature on the pathogenesis and clinical management of liver abscesses caused by ingested foreign is presented. BACKGROUND

Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

“…Patients may not recall the ingestion event, and radiological findings can be subtle 1. Extraluminal foreign body migration can have significant consequences, including mediastinitis, peritonitis, liver abscesses formation and splenic rupture 2–5. Portal vein thrombosis is a rare but serious complication of extraluminal foreign body migration, as presented in this case.…”

Laparoscopic retrieval of a sewing needle from the liver: A case report

“…Intra-operative ultrasound is a useful adjunct in identifying the location of a deeper intra-parenchymal foreign body [ 7 ]. Laparoscopic liver resection of the affected liver segment has been described for deeper objects [ 10 , 15 ]. Laparotomy is performed for patients presenting with an acute decompensation, as in the case of acute perforation of the GI tract [ 14 , 8 ].…”

Successful diagnosis and treatment of ingested wooden toothpicks

“…Foreign-body ingestion is a common phenomenon. [ 1 – 6 ] Once sharp bodies, such as toothpicks, pins, and fishbone, are ingested, perforation of the intestine is possible and should be taken seriously. Toothpicks are ingested accidentally for various reasons—the ingestion happens to people who are edentulous, alcoholics, or who are used to picking their teeth.…”

“…[ 2 , 5 , 7 – 9 ] About 54% of patients cannot explain when or how the toothpicks get into their bodies. [ 5 ] The symptoms of perforation are significantly different from relapsing blunt abdominal pain to typical peritonitis, [ 1 , 4 , 5 , 7 ] mainly depending on the location where a toothpick lodges. Overall, the low morbidity and confusing clinical presentations tend to misguide physicians.…”