A case of liver abscesses and porto-enteric fistula caused by an ingested toothpick: A review of the distinctive clinical and imaging features

Though foreign body (FB) ingestions are a relatively common occurrence in the bustling emergency department, particularly among children, the vast majority of FBs either pass uneventfully or can be retrieved endoscopically. Only a small percentage of patients will experience complications such as bowel obstruction, ischemia, or perforation that may progress to abscess, septic thrombophlebitis, peritonitis, or shock. Depending on their composition, small FBs can be very difficult to detect on computed tomography (CT). However, a delay in definitive treatment resulting from the failure to clinically or radiologically recognize that a FB may be responsible for the acute presentation can lead to substantial morbidity and mortality. We present a case of unresolving hepatic abscess and recurrent sepsis caused by a toothpick-induced porto-enteric fistula in which the FB was not initially identified, thereby leading to multiple treatment failures and readmissions. This is followed by a literature review with comprehensive discussion of the distinctive clinical and imaging features of migrated FB-induced liver abscesses.