An unusual cause of liver abscess

A 16-year-old girl presented with epigastric pain radiating to the right upper quadrant associated with anorexia and right upper quadrant swelling. Tenderness in the right upper quadrant and hepatomegaly were observed. Leukocytosis and elevated liver enzymes were noted. Erythrocyte sedimentation rate and C-reactive protein were 78 mm/h and 279 mg/L respectively. A radio-opaque, thin foreign body that was presumed to be a pin was observed on the abdominal film (Fig. 1A). Abdominal ultrasonography revealed a 3-cm-high echoic linear shadow in the left lobe, and a heterogeneous echo pattern, whose diameter was 5 cm, consistent with an abscess. Abdominal computed tomography scan revealed a low-density mass region with a high-density metallic foreign body in its centre (Fig. 1B). The patient did not remember ever having ingested a foreign body, when asked. People frequently swallow foreign bodies and these usually pass through the gastrointestinal tract without complications. However, intestinal perforations or abscesses can occur (1). Frequently, patients do not remember swallowing the foreign body and signs may appear months or even years later (2). Liver abscess is a rare complication of foreign body ingestion (2). However, different sharp objects, especially chicken/fish bones, as well as wooden/plastic toothpicks, can easily penetrate the gastric wall into the liver, with a consequent formation of a liver abscess (1–4). We emphasize that foreign bodies should be kept in mind in patients with liver abscess or unexplained right upper quadrant pain.