Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2023; 11(23): 5622-5627
Published online Aug 16, 2023. doi: 10.12998/wjcc.v11.i23.5622
Pyogenic liver abscess secondary to gastric perforation of an ingested toothpick: A case report
Yeshong Park, Ho-Seong Han, Yoo-Seok Yoon, Jai Young Cho, Boram Lee, MeeYoung Kang, Jinju Kim, Hae Won Lee
Yeshong Park, Ho-Seong Han, Yoo-Seok Yoon, Jai Young Cho, Boram Lee, MeeYoung Kang, Jinju Kim, Hae Won Lee, Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
Author contributions: Park Y and Lee HW contributed to manuscript writing and editing and data collection; Kang MY and Kim J contributed to data analysis; Cho JY and Lee B contributed to validation and project administration; Yoon YS and Han HS contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hae Won Lee, MD, PhD, Professor, Department of Surgery, Seoul National University Bundang Hospital, No. 173 Gumiro Beongil, No. 82 Bundanggu, Seongnam-si 13620, South Korea. lansh@snubh.org
Received: June 15, 2023
Peer-review started: June 15, 2023
First decision: July 4, 2023
Revised: July 7, 2023
Accepted: July 24, 2023
Article in press: July 24, 2023
Published online: August 16, 2023
Processing time: 61 Days and 12.5 Hours
Abstract
BACKGROUND

Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion. Less than 100 cases have been reported to date.

CASE SUMMARY

We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach. The patient presented with persistent epigastric pain. Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe. Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object. As the abscess was refractory to antibiotic treatment, laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma. Following surgery, symptoms fully resolved without any sequelae.

CONCLUSION

This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess, particularly in abscesses of unknown origin that are resistant to antibiotic therapy. Clinical suspicion, early diagnosis, and prompt removal of the foreign body could lead to improved outcomes in these patients.

Keywords: Foreign body ingestion; Liver abscess; Pyogenic liver abscess; Liver resection; Case report

Core Tip: Most ingested foreign bodies can be managed without intervention. In rare occasions, sharp objects might directly penetrate from the gastrointestinal tract into the liver. In such cases, early diagnosis and proper surgical management are necessary. We present a rare case of pyogenic liver abscess secondary to penetration of the stomach by an ingested toothpick. After administration of systemic antibiotics, laparoscopic removal of the foreign body was pursued. As the foreign body was not visible from the liver surface, left lateral sectionectomy was performed. Postoperative recovery was uneventful. In refractory liver abscesses, clinical suspicion for foreign body ingestion should be maintained.