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Review
, 20 (13), 3703-11

Successful Treatment of Liver Abscess Secondary to Foreign Body Penetration of the Alimentary Tract: A Case Report and Literature Review

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Review

Successful Treatment of Liver Abscess Secondary to Foreign Body Penetration of the Alimentary Tract: A Case Report and Literature Review

Lee-Won Chong et al. World J Gastroenterol.

Abstract

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%.

Keywords: Drainage; Endoscopy; Foreign body; Hepatic abscess; Laparotomy.

Figures

Figure 1
Figure 1
Imaging studies with contrast-enhanced computed tomography scan. A: A hyperdense linear foreign body embedded in the posterior wall of the antrum with transgastric penetration and attachment to the upper pancreatic border (arrow); B: Sagittal multiplanar reformation image demonstrating close contact of the foreign body to the pancreas without evidence of vascular injury (arrow).
Figure 2
Figure 2
Liver abscess demonstrated in imaging study. Contrast-enhanced computed tomography scan showing a 7-cm hypodense mass in the lateral segment of the left hepatic lobe (outlined by arrows).
Figure 3
Figure 3
Endoscopic retrieval of the foreign body penetrating the stomach. A: Removal of the toothpick penetrating the posterior wall of the gastric antrum by a pair of grasping forceps; B: The foreign body removed: a 7-cm long wooden toothpick with two sharp ends.

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