Pyogenic liver abscess caused by trans-gastric migration of a toothpick managed with laparoscopic left lateral sectionectomy and gastric perforation repair: a case report.

Background: Pyogenic liver abscess caused by migration of an ingested toothpick through occult gastrointestinal perforation is rare and may be missed. Case presentation: A 47-year-old woman presented with 2 weeks of fever and epigastric pain. Laboratory tests revealed leukocytosis (13.3 × 10^9/L) and elevated C-reactive protein (45.4 mg/L) with normal procalcitonin (0.03 ng/mL). Non-contrast CT demonstrated an abscess-like lesion in the left hepatic lobe with an intralesional linear hyperdense focus, suggesting a foreign body. After empirical broad-spectrum antibiotics, laparoscopic left lateral sectionectomy with gastric perforation repair was performed. An intact toothpick was retrieved from the abscess cavity, confirming the etiology. The postoperative course was uneventful. This case highlights the diagnostic value of a linear hyperdense focus within a left-lobe hepatic abscess on CT for suspecting foreign body migration and guiding timely source control. Conclusion: A linear hyperdense focus within a hepatic abscess on CT should raise suspicion for migrated gastrointestinal foreign body. Definitive cure requires prompt source control, including foreign body removal and repair of the perforation tract.