Liver abscess caused by toothpick and treated by laparoscopic left hepatic resection: case report and literature review

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.

Figure 1

Abdominal US demonstrating a linear echogenic foreign body in the left lobe of liver (arrow).

Figure 2

Contrast-enhanced CT scan of the abdomen demonstrating high-attenuation structure (arrow) in the left lobe of liver.

Figure 3

Macroscopic picture of the surgical specimen. Hepatic segment two and three were sectioned in the operative room and the foreign body was extracted from the liver parenchyma. The object appeared to be made of wood and resembled a full-size toothpick. Surgical pathology inspection confirmed the clinical diagnosis.