Thigh cellulitis caused by toothpick ingestion

Bone Missile: Unusual Foreign Body Presentation: A Case Report

CASE

We present a male patient in his third decade of life who presented with a painful mass in his left thigh 2 weeks after being involved in motor vehicle accident. The mass was found to be a piece of bone from a second person who had been involved in the same accident.

CONCLUSION

This report highlights a most unusual type of injury.

Necrotizing fasciitis from an iliopsoas muscle abscess caused by a toothpick: A case report and literature review

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Ingested toothpick caused gut injury are a rare event, but caused retroperitoneal infection are relatively rare.

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The diagnosis of psoas abscesses associated with toothpicks is challenging and should not be overlooked.

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Gastrointestinal symptoms are uncommon when the gut perforation site is over the retroperitoneal space.

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Appropriate early surgical intervention is recommended. Thorough debridement is essential if the origin of infection is unknown.

Introduction

Psoas muscle abscess is rare and can become more complicated to treat after they have progressed to necrotizing fasciitis. The data of secondary psoas muscle abscess cause by ingested toothpick are limited in the literature. We have done an extensive literature review and found a number of 8 cases (including our new case) of ingested toothpicks causing iliopsoas muscle abscess.

Presentation of case

We present a 70-year-old man with unremarkable medical history experienced left flank pain for several days with radiated to left thigh and unable to walk. He initially exhibited drowsiness at emergency department with fever and chillness. Computed tomography showed iliopsoas abscess and necrotizing fasciitis. This patient received emergent surgical debridement and a toothpick was found lodged in the deep portion of the left psoas muscle. He was tolerated to the treatment and discharged on 58 days after the operation.

Discussion

A review of the literature revealed only eight reported cases since 1946 (including ours) of ingested toothpicks migrating into the iliopsoas muscle and causing abscess formation or necrotizing fasciitis. Three of the cases did not exhibit gut perforation, possibly because of self-healing of the wound. Gastrointestinal symptoms are not always apparent when the perforation site is over the retroperitoneal space. Thorough debridement is essential if the origin of infection is unknown.

Conclusion

Ingestion of a foreign body may be asymptomatic, the present case and a review of the literature indicated that ingested toothpicks can cause severe morbidity or even mortality. The diagnosis of psoas abscesses associated with toothpicks is difficult, and such cases should not be overlooked. Appropriate early surgical intervention is recommended.

Treating an intramuscular abscess following toothpick injury in a diabetic patient: A case report and literature review (CARE Complaint)

RATIONALE

Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment.

PATIENT CONCERNS

A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra.

DIAGNOSIS

Intramuscular abscess associated with toothpick injury.

INTERVENTIONS

Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra.

OUTCOMES

A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day.

LESSONS

Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.

Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick

Patient: Male, 18

Final Diagnosis: Perforation

Symptoms: Abdominal pain

Medication: —

Clinical Procedure: Endoscopy

Specialty: Surgery

Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct

Foreign body ingestion is common, although perforation after ingestion is rare. We report a case of an ingested sharp wooden stick that perforated the proximal jejunum toward the renal vasculature, causing segmental renal artery thrombosis and renal infarct. The patient presented with severe abdominal pain and vomiting. A computed tomography scan revealed a linear opacity corresponding to the foreign body. The wooden stick was removed endoscopically through deep-push enteroscopy with a rat-tooth forceps. We report this unique case of perforation by a foreign body through the proximal jejunum to the left kidney, which was managed endoscopically.

A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

Foreign body ingestion is not an uncommon problem in clinical practice. While most ingested foreign bodies pass uneventfully through the gastrointestinal tract, sharp foreign bodies such as toothpicks should cause intestinal perforation. We reported the case of a perforation of the appendix caused by a toothpick, which also pierced the liver without hepatic damages, in a male with an intestinal malrotation and subhepatic appendix. The patient was admitted to our hospital for abdominal pain in the right upper quadrant. An abdominal computed tomography scan revealed the anomalous position of the first portion of the large intestine with inflamed appendix. A laparoscopic appendicectomy and the exploration of the abdominal cavity was performed using minimally invasive technique.

Computed Tomographic Detection of Toothpick Perforation of the Jejunum: Case Report and Review of the Literature

Foreign body ingestion is commonly encountered in the emergency department. Although in most cases, the ingested object will pass uneventfully in the feces [1], ingestion of sharp foreign bodies such as dental plates, sewing needles, toothpicks, fish bones and chicken bones carries increased risk of gastrointestinal perforation [2, 3, 4]. The use of toothpicks as both tooth-clearing implements and eating utensils increase the likelihood of toothpick unintentional ingestion [5]. Toothpicks account for 9% of reported foreign bodies ingested [6]. These pointed wooden bodies when accidentally swallowed are associated with higher risk of complications, such as gastric, small bowel or colonic perforation, obstruction, colonic impaction, gastrointestinal bleeding, subphrenic abscess, fistula formation, sepsis and/or death due to the damaged caused by the sharp pointed ends [7, 8, 9]. Unfortunately, many patients who ingested such objects fail to remember the mis-swallowing event when symptoms of perforation develop, making diagnosis problematic. We present a case of jejunal perforation secondary to an ingested wooden toothpick correctly diagnosed with Computed Tomography (CT).