title: Unusual differential diagnosis of upper abdominal pain.
abstract: We here present an interesting unusual case of upper abdominal pain. The patient was a 38-year-old man, who was admitted to our hospital complaining of right upper quadrant pain caused by a toothpick that perforated the anterior gastric wall and penetrated segment I of the liver. After endoscopic removal and an initially uneventful course, computed tomography revealed a perigastric abscess that was treated by repeated gastroscopic rinsing via an endoscopically placed catheter. After another three uneventful weeks, a liver abscess with minor tendency to constrict the portal vein was diagnosed, and a segment I liver resection together with abscess drainage was performed. The peculiarity of this case is the rarity of toothpick ingestion and gastric perforation in a young and healthy white Caucasian followed by development of a liver abscess after primary uneventful endoscopic removal. In light of this case, gastric perforation due to ingested foreign bodies such as toothpicks can be considered a rare cause of upper abdominal pain.
authors.affiliation: Department of General and Transplant Surgery, Innsbruck Medical University Hospital, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Lanthaler
authors.forename: Thomas
authors.initials: T
authors.lastname: Grissmann
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwentner
authors.forename: Hermann
authors.initials: H
authors.lastname: Nehoda