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Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval
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 ima...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Association of Hepato-Biliary-Pancreatic Surgery
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452798/ https://www.ncbi.nlm.nih.gov/pubmed/32843606 http://dx.doi.org/10.14701/ahbps.2020.24.3.362 |
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author | Kishawi, Sami Anderson, Mark Joseph Chavin, Kenneth |
author_facet | Kishawi, Sami Anderson, Mark Joseph Chavin, Kenneth |
author_sort | Kishawi, Sami |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7452798 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The Korean Association of Hepato-Biliary-Pancreatic Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-74527982020-09-03 Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval Kishawi, Sami Anderson, Mark Joseph Chavin, Kenneth Ann Hepatobiliary Pancreat Surg Case Report 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. The Korean Association of Hepato-Biliary-Pancreatic Surgery 2020-08-31 2020-08-31 /pmc/articles/PMC7452798/ /pubmed/32843606 http://dx.doi.org/10.14701/ahbps.2020.24.3.362 Text en Copyright © 2020 by The Korean Association of Hepato-Biliary-Pancreatic Surgery This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Kishawi, Sami Anderson, Mark Joseph Chavin, Kenneth Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title | Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title_full | Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title_fullStr | Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title_full_unstemmed | Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title_short | Toothpick in the porta: Recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
title_sort | toothpick in the porta: recurrent liver abscesses secondary to transgastric migration of a toothpick with successful surgical exploration retrieval |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452798/ https://www.ncbi.nlm.nih.gov/pubmed/32843606 http://dx.doi.org/10.14701/ahbps.2020.24.3.362 |
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