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August 10, 1984

Venturesome Toothpick: A Continuing Source of Pyogenic Hepatic Abscess

Author Affiliations

From the Medical Service, Stanford University Hospital, Stanford University Medical Center, Stanford, Calif.

JAMA. 1984;252(6):797-798. doi:10.1001/jama.1984.03350060041027

IN MOST instances, following their accidental ingestion, toothpicks, like other foreign bodies, may pass through the gastrointestinal tract without inducing injury.1 In the minority of cases, toothpicks may perforate the bowel wall and produce local or widespread peritonitis and abscess formation.1,2 The site of perforation is usually in the ileum, appendix, or colon.1 Occasionally, hepatic abscess may result from metastatic spread of infection via the portal vein.3 In a few cases, perforation has occurred in the wall of the stomach or duodenum, and the toothpick has then perforated the inferior vena cava2 or migrated to the liver and induced a pyogenic abscess.4 This report concerns an additional (third?5) example of the latter event in which appropriate diagnosis was complicated by findings suggestive of an acquired immunodeficiency.

Report of a Case  A 56-year-old white male barber was admitted to Stanford (Calif) University Hospital for