Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3703
Revised: December 24, 2013
Accepted: January 19, 2014
Published online: April 7, 2014
Processing time: 150 Days and 18.9 Hours
Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.
Core tip: Hepatic abscess caused by foreign body penetration of the alimentary tract is rare and most cases are treated surgically. We demonstrate the successful conservative treatment of a patient by combining endoscopic removal of the foreign body and broad-spectrum antibiotic coverage. A review of the literature highlighted the importance of ruling out the possibility of foreign body penetration of the alimentary tract in patients with liver abscesses and no identifiable underlying condition, particularly those refractory to conventional treatment. Appropriate diagnostic strategies, including imaging studies and surgical exploration, may be indicated for early diagnosis and timely treatment of this potentially lethal condition.