A woman developed severe blood poisoning and a swollen liver after she accidentally swallowed a toothpick.
The toothpick had perforated her esophagus and lodged in a lobe of her liver. The 45-year-old woman, who has not been identified, has now recovered after having the toothpick removed.
Researchers noted that swallowing "foreign bodies" is relatively common, particularly among children, but the subsequent development of a liver abscess, like the woman who swallowed a toothpick, is rare, with the first recorded incident dating back to 1898, according to the report published in the British Medical Journal.
The authors, from Bristol's Frenchay Hospital and Halifax University in Canada say that doctors should be aware and look out for signs of "foreign bodies" as detection can be challenging.
Investigators said that liver abscess has mostly been associated with accidently swallowing pins, nails, fish and chicken bones, rather than toothpicks, and that most foreign body mishaps don't cause damage unless they create an obstruction or chemical burn.
Researchers noted that foreign body material can be hard to deal with because they don't show up on conventional x-rays, patients rarely remember swallowing an object and symptoms don't often show up immediately, and when patients do seek medical attention, their symptoms are often nonspecific.
In this particular case, the woman was taken to the hospital with generalized gut pain and fever, accompanied by nausea, vomiting and low blood pressure.
Blood tests showed that the woman's liver enzymes were at higher-than-normal levels and an abdominal ultrasound scan revealed a puss-filled cavity, about an inch and a half long, within her liver. Afterwards, she had developed breathing difficulties and an infection as a result of blood and had to be taken to the intensive care unit with multiple organ failure.
Doctors treated the woman with antibiotics and found and removed the toothpick stuck in her liver using keyhole surgery.
Researchers said that there have only been 17 reported cases where people swallowed toothpicks and wound up with liver abscesses.
In another case similar to the toothpick case, a surgical swab left inside a woman's abdomen after surgery only came to light when she experienced persistent changes in her normal bowel habit.
However, the swab was clearly visible on a computerized tomography (CT) scan, and removal of the swab cleared all her symptoms.