Published online Aug 16, 2023. doi: 10.12998/wjcc.v11.i23.5622
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
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.
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.
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.
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.