682 Accidental Toothpick Ingestion Causing Liver Abscess – a Case Report and Review of Literature

Abstract

Abstract Introduction Perforation due to foreign body ingestion leading to pyogenic liver abscess is an unusual but fatal event. We present a rare case of accidentally ingested toothpick that perforated the duodenum and migrated to the liver causing abscess. Case Presentation A 40-year-old gentleman presented with symptoms and signs of sepsis. He reported having eaten dry fish and chicken with bones 4 days prior to presentation. Abdominal computed tomography (CT) scan revealed hepatic collection containing a linear object in the middle. Non-operative management improved patient’s general condition but an increase in the size of collection lead to operative management. Discussion Usual course of formation of a pyogenic liver abscess is due to ascending cholangitis or infections causing hematogenous spread. Such an event due to a foreign body perforating the gastro-intestinal tract and migrating to liver is rarely seen. Presentation ranges from mild abdominal pain to full blown septicemia. Diagnosis is challenging as patients may present with vague symptoms, or sometimes don’t even remember having ingested an indigestible object. A trial of conservative management can be given to stable patients who improve, but deterioration necessitates surgical intervention. Conclusions Pyogenic liver abscess due to foreign body ingestion leading to intestinal perforation and displacing to liver is seldom encountered, and a toothpick leading to such an event is a very rare event. Patients may improve clinically with non-operative management; definitive management lies in the surgical removal of foreign body.