Toothpick ingestion and migration into the liver through the colonic hepatic flexure: case presentation, management, and literature review

Abstract

Key Clinical MessageThe approach to toothpick ingestion and its complications should not be underestimated. The surgeon should be prepared for life‐threatening situations such as major vascular involvement, as well as highly specialized and technically challenging procedures, when the hepatic hilum is involved for instance. Referral to tertiary centers is sometimes mandatory.

Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm

“…[ 33 , 37 ] Colon takes the third place of the most common site of perforation reported (6 cases). [ 19 , 42 , 55 – 57 , 70 ] A proposed hypothesis stated that a thicker gut wall (stomach and colon) can make the foreign body to perforate more gradually, and the close proximity of the omentum and adjacent organs, such as the liver assists in “sealing” the perforation site without gross intra-peritoneal spillage of gastrointestinal contents. [ 84 , 85 ] Moreover, the surrounding inflammatory adhesion might form even before the perforation sealed.…”

Hepatic resection due to a fish bone

“…One case treated by percutaneous and surgical drainage recurred because the foreign body was not removed [ 11 ]. El Asmar et al reported a case of a hepatic abscess due to a toothpick that grew on antibiotics only (3.3 cm–6.0 cm), ending in a laparotomic wedge resection [ 12 ]. Chen et al reported a resolution rate of only 9,5% when the foreign body is not removed [ 3 ].…”

“…Conservative treatment with antibiotics only is accepted as first-line for patients unfit for invasive approaches, but always as a bridge to foreign body removal. Although removal can be achieved by endoscopy (when a part of the foreign body is still in the gut), transluminal endoscopy or US/CT guided percutaneous intervention, surgery still is the best treatment when the diagnosis is highly suspected or certain [ 3 , 12 ]. Open or laparoscopic surgery are both valid options.…”

“…Our report is the eleventh ( Table 1 ). Laparotomy [ [8] , [9] , [10] , 12 , 13 ] and laparoscopy [ 3 , 4 , [14] , [15] , [16] ] were used for hepatic resection in five patients each. Surgery was the first option in only five cases [ 3 , 8 , 9 , 12 , 14 ].…”

A toothpick inside the liver with no defined access: A rare cause of liver abscess

“…This article presents a rare case of liver abscess attributed to the migration of a toothpick. To the best of our knowledge, only 22 cases of hepatic abscess resulted from a toothpick have been documented in the English medical literature [2] , [3] , [4] , [5] , [6] . This case report is presented in accordance with SCARE criteria [7] .…”