Toothpicks and surgical swabs can wreak havoc in the gut when inadvertently swallowed or left behind after surgery

A woman developed severe blood poisoning (sepsis) and a liver abscess, after inadvertently swallowing a toothpick, which perforated her gullet and lodged in a lobe of her liver, reveals a case published in BMJ Case Reports.

Swallowing "foreign bodies" is relatively common, particularly among children, but the subsequent development of a liver abscess is rare, with the first recorded incident dating back to 1898, the authors point out.

But it has mostly been associated with inadvertently swallowing pins, nails, fish and chicken bones, rather than toothpicks.

Most foreign body mishaps don't do any damage unless they create an obstruction or chemical burn. But they can be difficult to deal with effectively, because they don't show up on conventional x-rays and symptoms are often non-specific and remote.

In this particular case the woman was admitted to hospital with generalised gut pain and fever, accompanied by nausea, vomiting, and low blood pressure.

An abdominal ultrasound scan revealed a liver abscess and the presence of a toothpick lodged in her liver. She subsequently developed breathing difficulties and systemic infection as a result of blood poisoning and had to be admitted to intensive care.

After extensive treatment with antibiotics she recovered, and the toothpick was removed using keyhole surgery, after which all her symptoms cleared.

In another case on a similar theme in BMJ Case Reports, a surgical swab left inside the abdomen after surgery to correct a prolapsed womb, only came to light when the patient experienced persistent changes in her normal bowel habit.

The swab, which was boring its way into the rectum, was clearly visible on a CT scan. Removal of the swab resolved her symptoms.

Accidentally leaving a swab inside a patient's body is sufficiently common—1 in every 1500 abdominal procedures—to have its own name: gossypiboma, derived from the Latin for cotton, gossypium, and the Swahili word boma, meaning place of concealment.

These two cases add to that of the woman who swallowed a biro, which still worked when it was removed after 25 years, and comprise an international online collection of case reports that now tops 4000.