Liver abscess induced by foreign body

Case contributed by Dr Renor Gonçalves de Castro Neto

Presentation

Patient present to emergency with abdominal pain, fever and malaise.

Patient Data

Age: 15 years
Gender: Male

Pyogenic abscess shows a multiseptate complex mass in the right liver lobe, measuring 13.0 x 9.0 x 12.0 cm. Note a transient hepatic attenuation difference (THAD) due to the hyperemic wall of the abscess. A linear foreign body can be seen, representing a toothpick.

Annotated image shows a linear foreign body (green arrow), representing a toothpick.

Case Discussion

The patient gave a history of swallowing a toothpick 7 days prior. 

80%-90% of ingested foreign bodies pass through the gut without complication. When symptoms arise they are usually secondary to obstruction. Gastrointestinal perforation has been reported in <1% of patients and the most commonly affected areas are the ileocecal, rectosigmoid and duodenum.

Development of hepatic abscess due to penetration induced by a foreign body is even more rare, with a few reported cases. 

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