In patients with sepsis of unclear etiology, it is advisable to look for the cause; because an early diagnosis of the cause of sepsis can be prognostically very relevant, as the medical history of a man shows, the Chinese doctors from the «Mianyang Central Hospital» in the journal «BMC Infectious Diseases» describe.
The patient and his history
The 51-year-old patient was admitted to the clinic because he had had right-sided back pain and blood in his urine for two days; He did not have a fever or other complaints, the authors report. Except for alcohol consumption, the anamnesis was empty.
The findings
- Feverish patient (temperature 38.9 °C), pulse 110 beats per minute, respiratory rate 21 breaths per minute, blood pressure 131/77 mmHg.
- Cardiopulmonary examination inconspicuous
- Abdomen and Renal region sensitive to pain
- Sonography of Renal and ureters: strong stripe echo in the middle part of the right kidney
- Abdominal CT: Exudation around the kidney and the right ureter
- Increased number of white blood cells and neutrophils in blood and urine
- C-reactive protein significantly increased
- Blood culture: detection of Streptococcus gordonii
Due to the suspicion of a foreign body, review of the abdominal CT image: It turned out that a duodenal foreign body had entered the right kidney.
The final diagnoses were therefore septicaemia, foreign bodies in the duodenum that had invaded the right kidney, and infection of the right kidney
Therapy and course
Endoscopic removal of a 5 cm long toothpicks and antibiotic therapy.
Postoperatively, the patient recalled that a month earlier he may have accidentally swallowed a toothpick while drinking .He was released from the hospital on the 15th day.
Discussion
Foreign bodies in the digestive tract are often observed in clinical practice, especially in children, the elderly and patients with mental illness. Foreign bodies in the digestive tract in adults are usually associated with alcohol consumption.
The patient in this case remembered that he may have accidentally swallowed a toothpick a month ago, but most patients can not remember the accidental ingestion of a foreign body.
Most foreign bodies in the digestive tract are excreted without causing clinical symptoms. However, some foreign bodies, especially sharp or pointed ones, such as toothpicks and herringbones, can lead to gastrointestinal perforation, which in turn can lead to sepsis.
The authors searched PubMed for articles on perforation of the digestive tract and sepsis caused by toothpicks.In previous case reports, according to them, unidentified foreign bodies that caused the very infectious focus that led to sepsis in the present case led to repeated hospitalizations of patients with sepsis. Therefore, it is essential to actively search for the source of infection in patients with fever and sepsis of unknown cause.
According to previous literature reports, the most common gastrointestinal perforation sites after ingestion of a toothpick are the duodenum, the small intestine, the large intestine or the stomach. A kidney injury caused by a duodenal foreign body is a rare case.
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