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

[Pyogenic hepatic abscess secondary to gastric perforation by a foreign body complicated by acute peritonitis: about a case at the Hôpital Principal de Dakar, Senegal]

Accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, however the development of hepatic abscesses secondary to digestive perforation by a foreign body is rare. We report the case of pyogenic hepatic abscesses secondary to gastric perforation by a fishbone complicated by acute peritonitis. A 53-year-old patient was admitted to our hospital with the main complaints: diffuse abdominal pain with vomiting in a context of fever and physical asthenia. A painful febrile hepatomegaly with jaundice was objectified, as well as a non-specific biological inflammatory syndrome. An initial abdominopelvic CT scan revealed multifocal liver abscesses. Faced with the initial therapeutic failure associating parenteral antibiotic therapy and abscess drainage, a second abdominal CT scan identified a foreign body straddling the antropyloric wall and segment I of the liver.A xypho-pelvic midline laparotomy was performed with nearly 200 cc of peritoneal fluid coming out. A fishbone approximately 5 cm long was extracted by laparotomy, followed by gastric closure with omentum, peritoneal cleansing and drainage. Symptomatic adjuvant treatment was initiated, including a proton pump inhibitor (Pantoprazole). He also benefited from transfusion support in the face of anemia. Antibiotic therapy was continued for a total of 2 weeks after surgery. The evolution was favorable with follow-up imaging at 3 months, showing complete resorption of the hepatic abscesses.

Management of Pyogenic Liver Abscesses: Contemporary Strategies and Challenges

Pyogenic liver abscesses (PLAs) are a suppurative infection of the hepatic parenchyma responsible for significant morbidity and mortality. PLAs are categorized into a variety of mechanisms: (1) via the portal vein, (2) through the biliary tract, (3) via the hepatic artery, (4) from trauma, (5) contiguously via direct extension, and (6) cryptogenically. The pathogenesis of PLA, which informs treatment, can often be discerned based on host factors, clinical presentation, and causative microorganisms. The Streptococcus anginosus group, hypervirulent Klebsiella pneumoniae , and multidrug-resistant gram-negative pathogens have emerged as microbiologically challenging organisms to treat. The identification of hypervirulent K. pneumoniae should prompt for assessment for metastatic spread and consideration of prolonged antimicrobial treatment. Abdominal imaging is indispensable in characterizing PLAs and facilitating source control interventions. Source control remains the most critical aspect of PLA management, followed by antimicrobial therapy. Empiric antibiotics for PLAs are informed by the suspected etiology of PLA formation. Duration of antimicrobial therapy is individualized and dependent on multiple components, including the success of achieving source control, host factors, mechanism of PLA development, and the illness course of the individual-factoring in clinical, biochemical, and radiographic parameters.

Pyogenic liver abscess secondary to gastric perforation of an ingested toothpick: A case report

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.

Sepsis due to kidney injury caused by a toothpick: a case report and literature review

BACKGROUND

Toothpicks are common foreign bodies which may injure surrounding organs leading to a series of atypical symptoms. We present a rare clinical case that septicemia caused by a toothpick penetrated into the right kidney.

CASE PRESENTATION

We describe a 51-year-old patient who presented with right-sided backache and hematuresis for 2 days. Blood culture persistently grew Streptococcus gordonii. Ultrasound of the patient's urinary tract revealed a strong striated echo in the middle of the right kidney. Complete abdominal computed tomography revealed a duodenal foreign body penetrating into the right kidney. The toothpick was removed under endoscopy and hemostasis was given. Antibiotic treatment was upgraded. The patient was recovered and discharged from his stay on the fifteenth day.

CONCLUSIONS

Early identification of the etiology of sepsis can effectively alleviate patient's distress and reduce hospital stay. Clinicians should identify the source of sepsis through a medical history and examination.

Laparoscopy treatment of liver abscess secondary to an unusual foreign body (rosemary twig)

A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.

Liver abscess caused by ingestion of fishbone: A case report

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.

Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient's upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient's hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review

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.

Laparoscopic retrieval of a sewing needle from the liver: A case report

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Ingested foreign bodies are a common presentation.

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Ingested foreign bodies can migrate/penetrate to the liver.

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Patients can present with symptoms including epigastric abdominal pain.

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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.

Successful diagnosis and treatment of ingested wooden toothpicks: Two case reports

RATIONALE

Foreign-body ingestion is a common phenomenon and foreign bodies are mostly excreted in stool. Once sharp bodies are ingested without being realized, perforation of intestine is possible and misdiagnosis may be made. We report 2 toothpick ingestion cases that were both diagnosed accurately.

PATIENT CONCERNS

We present 2 cases of middle-aged persons who suffered from abdominal pain. They did not realize and provide any information of having the history of swallowing foreign bodies.

DIAGNOSES

No serious problem was discovered in the examination and blood test. There were somewhere abnormal in computed tomography (CT) images and ultrasound (US). Then a toothpick was found penetrating the wall of intestine into the adjacent viscera in the laparotomy.

INTERVENTIONS

Both patients in the 2 cases were undergone operation to remove the toothpicks.

OUTCOMES

The 2 cases' prognoses were good.

LESSONS

When accepting patients with abdominal pain, suitable examining means and careful observation should be given to find easily ignored lesions. CT is recommended in the diagnostic process of swallowed foreign mass. When there is a vague place, US can be used for further diagnose.

Toothpick ingestion and migration into the liver through the colonic hepatic flexure: case presentation, management, and literature review

The approach to toothpick ingestion and its complications should not be underestimated. The surgeon should be prepared for life-threatening situations such as major vascular involvement, as well as highly specialized and technically challenging procedures, when the hepatic hilum is involved for instance. Referral to tertiary centers is sometimes mandatory.

Toothpick inside the Common Bile Duct: A Case Report and Literature Review

The incidence and prevalence of foreign body (FB) ingestion are difficult to estimate. Unlike other foreign bodies, the ingestion of a toothpick is very uncommon and carries high morbidity and mortality rates. We report a case of a 73-year-old female patient presenting mid-term epigastric pain. Abdominal ultrasound revealed a slightly dilated common bile duct (CBD) and magnetic resonance showed an irregular filling failure in distal CBD and gallstones. Endoscopic Retrograde Cholangiopancreatography revealed major papilla on the edge of a diverticulum and confirmed the distal filling failure. After sphincterotomy, a partially intact toothpick was extracted from the CBD. Neither fistulas nor perforation signs were found. Literature related to foreign bodies and toothpick ingestion was reviewed and some hypotheses to explain the reported case were created. To our knowledge, this is the first report of a toothpick lodged inside the biliary tract.

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review

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%.