Liver Abscess following Hematogenous Transmission due to Rectal Foreign Body Perforation
A 57-year-old male was referred for a colonoscopy due to bleeding from the rectum and rectal pain, but the colonoscopy could not be carried through as the patient was not sufficiently depleted. The next day the patient was admitted due to abdominal pain, hypotension and elevated white blood cell count (leukocytes 14 × 109/l) and C-reactive protein (200 mg/l). He was suspected to have cholecystitis and was started on antibiotic treatment, intravenous cefuroxime and metronidazole. Ultrasound examination showed no signs of cholecystitis but revealed a process of 5.5 cm in the right liver lobe, interpreted as a thrombosed hemangioma. The following magnetic resonance scan showed a liver abscess, which was drained percutaneously. Microbiological examination of the drain secretion only demonstrated growth of Streptococcus gordonii.\nA computed tomography (CT) scan was performed to clarify the etiology of the abscess. To our surprise a 3-cm-large presacral process was found with connection to the rectum via a 6.5-cm-long foreign body, similar to a toothpick (indicated by the arrows in fig. ). Subsequent sigmoidoscopy showed a toothpick placed transmurally in the rectum. During the sigmoidoscopy the toothpick was removed with a forceps (fig. ). The patient had no memory of swallowing a toothpick.\nAfter 15 days the patient was discharged, with a normal white blood cell count, C-reactive protein and a CT scan which verified regression of both the liver and sacral abscess.