KMID : 1143920200240030362
|
|
Annals of Hepato-Biliary-Pancreatic Surgery 2020 Volume.24 No. 3 p.362 ~ p.365
|
|
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
|
|
Abstract
|
|
|
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.
|
|
KEYWORD
|
|
Toothpick, Liver abscess, Porto-enteric fistula, Foreign body, Surgery
|
|
FullTexts / Linksout information
|
|
|
|
Listed journal information
|
|
|
|