Korean J Gastrointest Endosc.  2008 Jun;36(6):390-394.

A Case of Liver Abscess Associated with Duodenal Perforation by a Toothpick

• Park SJ
• Lee CG
• Kim SE
• Kim JH
• Lee KH
• Kim KY
• Yun JW
• Kim SY

Abstract

The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature.

Keyword

Toothpick; Duodenal perforation; Liver abscess; Actinomycosis

MeSH Terms

Abscess
Actinomycosis
Anti-Bacterial Agents
Drainage
Eating
Fever
Foreign Bodies
Humans
Liver
Liver Abscess
Nausea
Sulfur
Vomiting
Anti-Bacterial Agents
Sulfur