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Joueidi F, Alzahrani AA, Altaweel AA, Alwhaibi O, Elgohary A, Bin Saad KO. Migrated toothpick causing a hepatic abscess with portal vein thrombosis: A case report and review of literature. Clin Case Rep 2024; 12:e9332. [PMID: 39176102 PMCID: PMC11338838 DOI: 10.1002/ccr3.9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/25/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024] Open
Abstract
Key Clinical Message Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54-year-old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick. Abstract Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%-90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54-year-old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course.
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Affiliation(s)
- Faisal Joueidi
- College of MedicineAlfaisal University RiyadhRiyadhSaudi Arabia
| | | | | | - Omar Alwhaibi
- College of MedicineImam Muhammad Bin Saud Islamic UniversityRiyadhSaudi Arabia
| | - Ahmed Elgohary
- Department of Hepatobiliary SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Khalid O. Bin Saad
- Department of Hepatobiliary SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
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Taieb AH, Chaouch MA, Kaouach A, Ben Jabra S, Zayati M, Gafsi B, Mili E, Noomen F. An uncommon liver abscess secondary to an ingested foreign body: A case report. IDCases 2024; 36:e01934. [PMID: 38601431 PMCID: PMC11002799 DOI: 10.1016/j.idcr.2024.e01934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.
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Affiliation(s)
- Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Aymen Kaouach
- Department of General Surgery, Sidi Bouzid Hospital, Sidi Bouzid, Tunisia
| | - Sadok Ben Jabra
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Emna Mili
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Chen H, Zeng Y. Letter to the Editor: Hepatic Abscess Caused by the Migration of a Fish Bone. Surg Infect (Larchmt) 2024; 25:79-80. [PMID: 38153971 DOI: 10.1089/sur.2023.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Hao Chen
- Department of Liver Surgery and Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
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Minh LHN, Han LTK, Hau NV, Kiet NA, Phong TT, Duong NK, Yen PTH, Vinh NX, Nguyen HQ, Le NQK. Liver abscess caused by the ingested foreign body without sign of gastrointestinal perforation: A case report. Radiol Case Rep 2023; 18:4404-4408. [PMID: 37829164 PMCID: PMC10565680 DOI: 10.1016/j.radcr.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.
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Affiliation(s)
- Le Huu Nhat Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- AIBioMed Research Group, Taipei Medical University, Taipei 110, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110, Taiwan
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Luu Thi Kim Han
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Viet Hau
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Anh Kiet
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Tang Tuan Phong
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Khanh Duong
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Phan Thi Hoang Yen
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Xuan Vinh
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Hien Quang Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410, USA
| | - Nguyen Quoc Khanh Le
- AIBioMed Research Group, Taipei Medical University, Taipei 110, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110, Taiwan
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
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Hassan B, Maree G, Hassan A. A toothpick inside the liver with no defined access: A rare cause of liver abscess. Int J Surg Case Rep 2023; 106:108271. [PMID: 37130480 PMCID: PMC10172779 DOI: 10.1016/j.ijscr.2023.108271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Foreign body ingestion is not an uncommon occurrence, whereas the complications that may be generated by it are infrequent. The clinical manifestation range from nonspecific symptoms to life threatening conditions. Therefore, these cases continue to be challenging in diagnosis and treatment, especially items that are not radio-opaque. CASE PRESENTATION This article demonstrates a rare case of liver abscess induced by a toothpick with an unknown access. A 64-year-old woman was admitted to the Intensive Care Unit when she had developed a septic shock due to liver abscess and a conservative treatment was provided. After that, the patient underwent surgery to extract the foreign body. DISCUSSION Tracking the ingested foreign body is not always effortless. Computed Tomography scan plays a significant role in discovering foreign bodies located inside the liver. Surgical intervention is mostly required to remove the foreign body. CONCLUSION Foreign body presence inside the liver is a rare incident. The symptoms vary from case to another and whether it is silent or not, it is preferable to remove the foreign body.
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Affiliation(s)
- Bushra Hassan
- Faculty of Medicine, Tishreen University, Lattakia, Syria.
| | - Gulan Maree
- Paediatric surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - AlYakzan Hassan
- General Surgery Department, Tishreen Hospital, Damascus, Syria
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Hao F, Feng Q, Li J, Wu H. An ingested metallic wire migrating from stomach to pancreas treated by laparoscopic surgery: A case report. Front Surg 2023; 9:927637. [PMID: 36684257 PMCID: PMC9852039 DOI: 10.3389/fsurg.2022.927637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/08/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects such as a fish bone, a sewing needle, or a toothpick. Furthermore, an ingested metallic wire migrating from stomach to pancreas is very rare. CASE PRESENTATION We report a 36-year-old woman who was admitted to our hospital with "3-day history of dull progressive epigastric pain." Computed tomography of the abdomen revealed a linear, high-density body between the stomach wall and the pancreas. During the operation, a linear, hard, metallic wire was found in the adhesive tissue between the gastric antrum and the pancreatic body. The operation was uneventful, and the patient recovered well. CONCLUSION The case of a foreign body inside the pancreas caused by a metallic wire is very rare. Radiological examinations play a vital role in the diagnosis of metallic wire ingestion. Metallic wire ingestion can be treated with laparoscopic surgery, both technically and safely.
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Affiliation(s)
- Fulong Hao
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of Hepatobiliary Surgery, Suining First People's Hospital, Suining, China
| | - Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaxin Li
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
- Dafang County People's Hospital, Bijie, China
| | - Hong Wu
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
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Kadi A, Tuergan T, Abulaiti Y, Shalayiadang P, Tayier B, Abulizi A, Tuohuti M, Ahan A. Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report. World J Clin Cases 2022; 10:13402-13407. [PMID: 36683634 PMCID: PMC9850996 DOI: 10.12998/wjcc.v10.i36.13402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/28/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.
CASE SUMMARY This report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient's general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory.
CONCLUSION PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.
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Affiliation(s)
- Abudureyimu Kadi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yierpan Abulaiti
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Paizula Shalayiadang
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Baihetiyaer Tayier
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Abududuaini Abulizi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Muniremu Tuohuti
- Department of General Medicine, First People's Hospital of Aksu Region, Aksu 843099, Xinjiang Uygur Autonomous Region, China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Feng Q, Du J, Liao W, Zheng J, Zeng Y, Li J. Uncommon Cause of Right Upper Quadrant Pain Treated by Laparoscopic Surgery: A Case Report. Front Surg 2022; 9:891366. [PMID: 35615645 PMCID: PMC9126434 DOI: 10.3389/fsurg.2022.891366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Right upper quadrant pain is a very common symptom of cholecystitis. Right upper quadrant pain caused by fish bone perforation of the stomach wall is rare. CASE PRESENTATION We report a 42-year-old woman who was admitted to our hospital with "1-month history of dull progressive right upper quadrant pain radiating to the back." Computed tomography of the abdomen revealed a linear, high-density body between the stomach wall and the liver. On history, the patient stated she had eaten a bony fish a month prior but did not note any significant pain at the time. Laparoscopy revealed a fish bone 2 cm in length half on the surface of the caudate lobe of the liver, and no perforation of the gastrointestinal tract was found. The postoperative course was uncomplicated, and the patient was discharged home on day 3 after surgery. CONCLUSION The case of right upper quadrant pain caused by the fish bone is very rare. Radiological examinations play a significant role in the diagnosis of fish bone ingestion. Laparoscopic surgery is technically feasible and safe for the treatment of patients with fish bone ingestion.
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Affiliation(s)
| | | | | | | | | | - Jiaxin Li
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Subasinghe D, Jayasinghe R, Kodithuwakku U, Fernandopulle N. Hepatic abscess following foreign body perforation of the colon: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221103357. [PMID: 35707053 PMCID: PMC9189518 DOI: 10.1177/2050313x221103357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Liver abscess following foreign body perforation of the gastrointestinal tract is uncommon. Preoperative diagnosis is challenging as the ingestion of foreign body most often goes unnoticed with non-specific presentation. We report a case of a 68-year-old male patient presenting with abdominal pain and anorexia. His investigations and cross-sectional imaging revealed a liver abscess. A colonoscopy performed to find an etiology revealed an incidental finding of a colonic perforation from an impacted denture, which was successfully removed endoscopically. Therefore, pyogenic liver abscesses remain a therapeutic challenge despite advances in imaging and therapy. The case reflects the importance of investigating for etiology of unexplained liver abscesses. The patient made an uneventful recovery following abscess drainage by image-guided pigtail stent insertion. The colonic perforation was managed conservatively.
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Affiliation(s)
- Duminda Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Surgical Unit,The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Ravindri Jayasinghe
- University Surgical Unit,The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Uditha Kodithuwakku
- Department of Radiology,The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Nilesh Fernandopulle
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Surgical Unit,The National Hospital of Sri Lanka, Colombo, Sri Lanka
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Costa Almeida CE, Caroço T, Silva M, Baião JM, Guimarães A, Ângelo M. Hepatic resection due to a fish bone. Int J Surg Case Rep 2021; 81:105722. [PMID: 33714000 PMCID: PMC7957144 DOI: 10.1016/j.ijscr.2021.105722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Hepatic abscess due to a foreign body is rare. Diagnosis is difficult since symptoms are non-specific. Stomach and duodenum are the common sites of perforation. Antibiotics with abscess drainage and foreign body removal is the most frequently used treatment. Hepatic resection is rarely needed, but surgeons must be aware of its possibility. Introduction and importance Hepatic abscess due to foreign body is rare. Diagnosis is difficult and drainage may not be enough. Hepatic resection may be indicated. Case presentation A 76yo male patient resorted to the emergency room because of fever and abdominal pain. Abdominal CT diagnosed a hepatic abscess in the left lobe due to a fishbone. Percutaneous and surgical drainage failed. Laparotomic hepatic resection was necessary. The patient was discharged asymptomatic. Clinical discussion Liver abscess due to foreign body usually occur in the left lobe. Drainage and removal of the foreign body are mandatory and can be achieved either by percutaneous or surgical drainage. Resection is rarely indicated but sometimes is the only way. The authors found only ten cases of hepatic resection due to pyogenic abscess because of a foreign body. Conclusions Hepatic resection is rarely needed to treat a pyogenic abscess, but surgeons must be aware and able to proceed with it.
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Affiliation(s)
| | - Teresa Caroço
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal.
| | - Marta Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - José Miguel Baião
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal.
| | | | - Miguel Ângelo
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal.
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Kishawi S, Anderson MJ, Chavin K. Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval. Ann Hepatobiliary Pancreat Surg 2020; 24:362-365. [PMID: 32843606 PMCID: PMC7452798 DOI: 10.14701/ahbps.2020.24.3.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
We present a rare case of a 72-year-old man with recurrent hepatic abscesses secondary to transgastric migration of a toothpick into the liver parenchyma and left portal venous branch. Prior to identification of the foreign body, the patient received multiple courses of antibiotics and underwent image-guided catheter placement without resolution of infection. Given his refractory abdominal pain, fevers, and chills, a repeat abdominal CT was obtained and demonstrated a radio-opaque object extending through the prepyloric gastric submucosa into the liver parenchyma and left portal vein. EGD confirmed a pre-pyloric fistula tract with purulent discharge. The patient subsequently underwent exploratory laparotomy, cholecystectomy, porta hepatis exploration, removal of foreign body, and ligation of porto-enteric fistula tract. A wooden toothpick was removed in its entirety. Interval CT demonstrated resolution of hepatic abscesses and no evidence of persistent porto-enteric fistula. This exceptional case demonstrates the value of multidisciplinary care, hypervigilance for patients with refractory pyogenic liver abscesses of unknown origin, and the importance of careful preoperative planning.
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Affiliation(s)
- Sami Kishawi
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Joseph Anderson
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Chavin
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Abstract
RATIONALE The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study. PATIENT CONCERNS A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest. DIAGNOSIS AND INTERVENTION Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection. OUTCOMES The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation. LESSONS Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.
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13
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Chen J, Wang C, Zhuo J, Wen X, Ling Q, Liu Z, Guo H, Xu X, Zheng S. Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e14705. [PMID: 30882633 PMCID: PMC6426515 DOI: 10.1097/md.0000000000014705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare. PATIENT CONCERNS A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months. DIAGNOSIS A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy. INTERVENTIONS The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length. OUTCOMES The patient recovered uneventfully and was discharged on day 5 after surgery. LESSONS This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.
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Affiliation(s)
- Jun Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Carver D, Bruckschwaiger V, Martel G, Bertens KA, Abou-Khalil J, Balaa F. Laparoscopic retrieval of a sewing needle from the liver: A case report. Int J Surg Case Rep 2018; 51:376-378. [PMID: 30268064 PMCID: PMC6170216 DOI: 10.1016/j.ijscr.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/20/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023] Open
Abstract
Ingested foreign bodies are a common presentation. Ingested foreign bodies can migrate/penetrate to the liver. Patients can present with symptoms including epigastric abdominal pain. In some cases hepatic foreign bodies can be extracted through a laparoscopic approach. Introduction Less than 1% of ingested foreign bodies will require surgical management. An uncommon complication of ingested foreign body is migration to the liver. We present a case of laparoscopic removal of an intrahepatic foreign body. Presentation of case 32-year-old female presented with a four month history of epigastric abdominal pain following suspected foreign body ingestion. CT scan demonstrated a metallic object lying in the left lateral segment of the liver. The patient was brought to the operating room where the object was removed laparoscopically and was found to be a sewing needle. Discussion Hepatic foreign bodies are an uncommon entity and typically result from a transcutaneous or ingested (e.g., gastrointestinal) source. Symptoms are often vague and can develop remote from the time of ingestion. Surgical management is warranted for symptomatic intrahepatic foreign bodies. Conclusion Laparoscopy is an effective surgical method for removal of intrahepatic foreign bodies in some cases.
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Affiliation(s)
- David Carver
- University of Ottawa, The Ottawa Hospital, Canada
| | | | | | | | | | - Fady Balaa
- University of Ottawa, The Ottawa Hospital, Canada.
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Zhou Q, Singh N, Monteforte B. Toothpick meningitis. Radiol Case Rep 2017; 12:265-268. [PMID: 28491166 PMCID: PMC5417632 DOI: 10.1016/j.radcr.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/11/2016] [Accepted: 10/23/2016] [Indexed: 01/26/2023] Open
Abstract
A 66-year-old male with a history of hypertension, back pain, diverticulosis and anal fistula presents with acute onset syncopal episodes, worsening back pain, and altered mental status. The patient exhibited considerable leukocytosis but was hemodynamically stable. CT imaging of the head revealed a gas pattern in the posterior fossa and velum interpositum. CT imaging of the abdomen and pelvis revealed a needle-like foreign body traversing the left sacrum to the sigmoid colon. A lumbar puncture revealed meningitis. Flexible sigmoidoscopies were performed without successful visualization of the foreign body. An explorative laparoscopy was successfully performed, enabling retrieval of what was determined to be a wooden toothpick. The patient remained hemodynamically stable with persistent altered mental status and was eventually discharged after completion of antibiotics on day 47 of hospitalization. This case illustrates a rare complication of ingesting a sharp foreign body that was identified by CT of the brain and abdomen/pelvis with successful surgical repair.
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Affiliation(s)
- Qiao Zhou
- Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23510, USA
| | - Neera Singh
- Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23510, USA
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16
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Abstract
This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients.
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17
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Computed Tomographic Detection of Toothpick Perforation of the Jejunum: Case Report and Review of the Literature. Radiol Case Rep 2016; 2:17-21. [PMID: 27303454 PMCID: PMC4891581 DOI: 10.2484/rcr.v2i1.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Foreign body ingestion is commonly encountered in the emergency department. Although in most cases, the ingested object will pass uneventfully in the feces [1], ingestion of sharp foreign bodies such as dental plates, sewing needles, toothpicks, fish bones and chicken bones carries increased risk of gastrointestinal perforation [2, 3, 4]. The use of toothpicks as both tooth-clearing implements and eating utensils increase the likelihood of toothpick unintentional ingestion [5]. Toothpicks account for 9% of reported foreign bodies ingested [6]. These pointed wooden bodies when accidentally swallowed are associated with higher risk of complications, such as gastric, small bowel or colonic perforation, obstruction, colonic impaction, gastrointestinal bleeding, subphrenic abscess, fistula formation, sepsis and/or death due to the damaged caused by the sharp pointed ends [7, 8, 9]. Unfortunately, many patients who ingested such objects fail to remember the mis-swallowing event when symptoms of perforation develop, making diagnosis problematic. We present a case of jejunal perforation secondary to an ingested wooden toothpick correctly diagnosed with Computed Tomography (CT).
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18
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Chong LW, Sun CK, Wu CC, Sun CK. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review. World J Gastroenterol 2014; 20:3703-3711. [PMID: 24707157 PMCID: PMC3974541 DOI: 10.3748/wjg.v20.i13.3703] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
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%.
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19
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Accidentally Ingested Toothpicks Causing Severe Gastrointestinal Injury: A Practical Guideline for Diagnosis and Therapy Based on 136 Case Reports. World J Surg 2013; 38:371-7. [DOI: 10.1007/s00268-013-2307-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Abu-Wasel B, Eltawil KM, Keough V, Molinari M. Liver abscess caused by toothpick and treated by laparoscopic left hepatic resection: case report and literature review. BMJ Case Rep 2012; 2012:bcr-2012-006408. [PMID: 22969156 DOI: 10.1136/bcr-2012-006408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hepatic abscesses caused by ingested foreign bodies have been reported in the medical literature but represent very uncommon events. Extra-luminal migration of sawing needles and pins is the most common cause of perforation of the gastrointestinal tract associated with liver infections. Other non-metallic sharp objects such as animal bones and toothpicks have been described but are less frequent. The authors present a case of a 45-year-old woman who suffered from sepsis and a liver abscess because of the migration of a toothpick that lodged in the left hepatic lobe. Review of the literature on the pathogenesis and clinical management of liver abscesses caused by ingested foreign is presented.
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Affiliation(s)
- Bassam Abu-Wasel
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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21
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González Carrera V, Vázquez Rodríguez S, Pereiro Carbajo A, Álvarez Sánchez V, Turnes Vázquez J. [Liver abscess as a delayed complication of a gastrointestinal foreign body]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:720. [PMID: 22000029 DOI: 10.1016/j.gastrohep.2011.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 06/08/2011] [Indexed: 10/16/2022]
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22
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Choi H, Lee Y, Wang J, Yeon S, Lee H, Lee H. Metallic foreign body in the liver of a dog. J Vet Med Sci 2010; 72:1487-90. [PMID: 20567094 DOI: 10.1292/jvms.10-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 4-year-old beagle had intermittent vomiting and weight loss for 1 month. On plain radiography, an approximately 3.5-cm, radiopaque, linear foreign body was identified in the region of the liver. On ultrasonography, a hyperechoic linear structure with reverberation was identified in the left lobe or quadrate lobe. On computed tomography(CT), a thin hyperattenuating material consistent with a metallic foreign body was identified just medial to the gall bladder. Removal of the foreign body was performed without complications. We present a rare case in which a metallic foreign body was embedded in the liver asymptomatically and found incidentally during a clinical examination performed to ascertain the cause of clinical signs.
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Affiliation(s)
- Hojung Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
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23
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Absceso hepático secundario a la impactación de un cuerpo extraño en la pared colónica. Rev Clin Esp 2010; 210:e13-5. [DOI: 10.1016/j.rce.2009.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/14/2009] [Accepted: 12/26/2009] [Indexed: 01/30/2023]
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24
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Leggieri N, Marques-Vidal P, Cerwenka H, Denys A, Dorta G, Moutardier V, Raoult D. Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore) 2010; 89:85-95. [PMID: 20517180 DOI: 10.1097/md.0b013e3181d41c38] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.
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Affiliation(s)
- Nicola Leggieri
- From Service de Maladies Infectieuses et Laboratoire Central de Bactériologie (NL), Hôpitaux Universitaires de Genève, Geneva, Switzerland; Institut Universitaire de Médecine Sociale et Préventive (PMV), Service deRadiologie (AD), Service de Gastroentérologie et d'Hépatologie (GD), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Surgery (HC), Medical University of Graz, Graz, Austria; Service de Chirurgie Viscérale (VM), Hôpital Nord, Marseille, France; and Unité des Rickettsies (DR), Centre Nationale de Recherche Scientifique, Unité Mixte de Recherche, Marseille, France
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25
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Affiliation(s)
- Sevil Ariyuca
- Department of Pediatrics, Medicine Faculty, Yuzuncu Yil University, Van, Turkey
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26
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Su YJ, Lai YC, Chen CC, Tang C. Intra-abdominal abscess caused by toothpick injury. Int J Infect Dis 2009; 13:e264-e266. [PMID: 19095482 DOI: 10.1016/j.ijid.2008.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 02/07/2023] Open
Abstract
We present the case of a 42-year-old female who presented to our emergency department (ED) complaining of epigastric pain for four days. She had been seen in the outpatient department and ED previously for evaluation, but continued to experience epigastric pain with fever. Emergency panendoscopy was performed and a toothpick was discovered impacted in the duodenal bulb. The gastroenterologist was unable to remove the toothpick endoscopically. Computed tomography of the abdomen revealed a long and straight hyperdense foreign body, and intra-abdominal abscess formation. An emergency laparotomy was performed. The patient recovered gradually and was discharged 11 days later. She could not remember when she swallowed the wooden toothpick, but guessed that it was while out drinking. There is an old wives' tale in Taiwan that putting a toothpick in the cup while drinking beer reduces the likelihood of abdominal distention from the carbonation of the beer.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei 112, Taiwan.
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27
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Gastric perforation by a toothpick causing a liver abscess. Eur Surg 2008. [DOI: 10.1007/s10353-008-0398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Karamarkovic AR, Djuranovic SP, Popovic NP, Bumbasirevic VD, Sijacki AD, Blazic IV. Hepatic abscess secondary to a rosemary twig migrating from the stomach into the liver. World J Gastroenterol 2007; 13:5530-5532. [PMID: 17907303 PMCID: PMC4171294 DOI: 10.3748/wjg.v13.i41.5530] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/28/2007] [Accepted: 08/17/2007] [Indexed: 02/06/2023] Open
Abstract
The ingestion of a foreign body that penetrates the gastric wall and migrates to the liver, where it causes an abscess is uncommon. A case of an ingested rosemary twig perforating the gastric antrum, then migrating to the liver, complicated by hepatic abscess and Staphylococcus aureus sepsis is reported. A 59-year-old man without a history of foreign body ingestion was admitted to our hospital because of sepsis and epigastralgia, which had progressively worsened. No foreign body was identified at preoperative imaging, but a rosemary twig was discovered during laparotomy. The liver abscess and sepsis were controlled successfully with surgery and antibiotics. This unusual condition should be kept in mind when dealing with cases of hepatic abscess, or even sepsis of unknown origin. Despite the improvement of non-surgical techniques such as percutaneous drainage and interventional endoscopy, surgery still remains important in the treatment of hepatic abscess caused by an ingested foreign body.
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Affiliation(s)
- Aleksandar-R Karamarkovic
- Center for Emergency Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
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29
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Liu YY, Tseng JH, Yeh CN, Fang JT, Lee HL, Jan YY. Correct diagnosis and successful treatment for pericardial effusion due to toothpick injury: A case report and literature review. World J Gastroenterol 2007; 13:4278-81. [PMID: 17696263 PMCID: PMC4250633 DOI: 10.3748/wjg.v13.i31.4278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.
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Affiliation(s)
- Yu-Yin Liu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, China
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30
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Santos SA, Alberto SCF, Cruz E, Pires E, Figueira T, Coimbra E, Estevez J, Oliveira M, Novais L, Deus JR. Hepatic abscess induced by foreign body: Case report and literature review. World J Gastroenterol 2007; 13:1466-70. [PMID: 17457985 PMCID: PMC4146938 DOI: 10.3748/wjg.v13.i9.1466] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
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Affiliation(s)
- Sofia A Santos
- Department of Gastroenterology, Fernando Fonseca Hospital, Amadora 2720-276, Portugal.
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31
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Matsubara M, Hirasaki S, Suzuki S. Gastric penetration by an ingested toothpick successfully managed with computed tomography and endoscopy. Intern Med 2007; 46:971-4. [PMID: 17603235 DOI: 10.2169/internalmedicine.46.0037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 31-year-old woman who had ingested a toothpick consulted our hospital because of epigastralgia. An abdominal computed tomography (CT) demonstrated a toothpick penetrating the gastric wall. Endoscopic examination demonstrated an ingested toothpick protruding from the prepyloric antrum. The whole toothpick was removed using a basket catheter without complications. CT images were useful to acquire clinical information such as location of the toothpick end. Unintentional ingestion of toothpicks must be considered potentially dangerous. The locations of both ends of the toothpick should be confirmed by CT or ultrasonography; and then, the toothpick should be removed as soon as possible.
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Affiliation(s)
- Minoru Matsubara
- Second Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama
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32
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Chiang TH, Liu KL, Lee YC, Chiu HM, Lin JT, Wang HP. Sonographic diagnosis of a toothpick traversing the duodenum and penetrating into the liver. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:237-40. [PMID: 16673366 DOI: 10.1002/jcu.20200] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Ingested foreign bodies rarely cause gastrointestinal perforation, because the majority are passed out uneventfully in the feces. However, long, sharp, slender, hard, indigestible objects such as toothpicks are dangerous and may lead to potentially life-threatening complications. We report a case of duodenal perforation caused by a toothpick and complicated by liver abscess and methicillin-resistant Staphylococcus aureus sepsis. Although laparotomy was not performed because of the patient's refusal to undergo surgery, the liver abscess and sepsis were controlled successfully with antibiotics. We also conducted a literature search for reports on injuries caused by ingested toothpicks.
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Affiliation(s)
- Tsung-Hsien Chiang
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
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Abstract
Although foreign body ingestion is relatively common, toothbrush swallowing is rare. We report a case of a swallowed toothbrush which passed through the ileocecal valve and perforated the proximal transverse colon, then the liver. To our knowledge, this is the first case to be reported.
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Affiliation(s)
- Min-Ro Lee
- Department of Surgery, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea
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34
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Lee KF, Chu W, Wong SW, Lai PBS. Hepatic abscess secondary to foreign body perforation of the stomach. Asian J Surg 2005; 28:297-300. [PMID: 16234084 DOI: 10.1016/s1015-9584(09)60365-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Foreign body penetration of the stomach is seldom encountered in general surgical practice. Liver abscess as a consequence of such occurrence has only been reported sporadically. We report three cases of liver abscesses due to direct penetration injury of the stomach by ingested foreign bodies. All three patients presented with clinical features of liver abscess without history of foreign body ingestion. All recovered with surgical treatment. Successful management relies on prompt recognition and early intervention as deaths have been reported due to missed or delayed diagnosis. The potential role of a minimally invasive approach in the management of this entity is also discussed.
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Affiliation(s)
- Kit-Fai Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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35
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36
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Chintamani, Singhal V, Lubhana P, Durkhere R, Bhandari S. Liver abscess secondary to a broken needle migration--a case report. BMC Surg 2003; 3:8. [PMID: 14531934 PMCID: PMC239862 DOI: 10.1186/1471-2482-3-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 10/07/2003] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain. CASE REPORT A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery. CONCLUSION It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.
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Affiliation(s)
- Chintamani
- Department of Surgery and Radiology, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi-110023, India.
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