Liver Abscess Caused by an Unnoticed Swallowed Toothpick Perforating the Colonic Wall

Abstract

We present an unusual case of a liver abscess caused by a swallowed toothpick in a 43-year-old man. The abscess was first punctured under percutaneous ultrasound control and intraveneous administration of antibiotics whereas the diagnosis of the foreign body stuck in the sigmoid bowel wall was only made by a follow-up computed tomography since the patient had no complains indicating a colonic pathology. Even more, the patient did not remember ever having ingested a foreign body. The wooden toothpick was then successfully removed by endoscopy. The case report stresses the need for a search of the cause of unexplained liver abscesses and highlights the importance of computed tomography as the first imaging technique as the foreign body was missed on the ultrasound examination. Finally, the non-surgical treatment as first line management of liver abscesses will be discussed.

Liver Abscess following Hematogenous Transmission due to Rectal Foreign Body Perforation

“…cholangitis, or in connection with interventions in the biliary tract, e.g. endoscopic retrograde cholangiopancreatography [3]. Other causes of pyogenic liver abscesses are appendicitis, pancreatitis, diverticulitis or perforation of the small or large intestine by foreign bodies, colonic cancer or high-grade polyps [3, 4].…”

“…endoscopic retrograde cholangiopancreatography [3]. Other causes of pyogenic liver abscesses are appendicitis, pancreatitis, diverticulitis or perforation of the small or large intestine by foreign bodies, colonic cancer or high-grade polyps [3, 4]. In the case of foreign body perforation the liver abscess is often formed by perforation of the upper gastrointestinal tract directly into the liver, but in rare cases the abscess is formed due to hematogenous transmission.…”

“…Detection of only one microorganism in the material indicates hematogenous transmission [2, 3]. Escherichia coli , Streptococcus , Klebsiella and Bacteroides species are often shown in connection with pyogenic abscesses [3].…”

“…Liver abscess due to hematogenous transmission from a gastrointestinal perforation caused by a foreign body is a rare and life-threatening condition [1, 2, 3]. This report describes a patient with a liver abscess caused by toothpick perforation of the rectum.…”

An Unusual Zoonosis: Liver Abscess Secondary to Asymptomatic Colonic Foreign Body

“…This is of particular significance for patients possessing a paucity of risk factors for portal or systemic sepsis and those who remain asymptomatic from clinically quiescent, but obviously important foci of sepsis. Case reports of liver abscess with asymptomatic colonic foreign body and without recognition of ingestion have been previously reported twice [4, 6]. Authors stress that in such cases, CT is an invaluable diagnostic aid as a means of not only quantifying the liver insult but also identifying the foreign body of interest.…”