Radiological diagnosis of a small bowel perforation secondary to toothpick ingestion

Case report and literature review: Orally ingested toothpick perforating the lower rectum

Introduction

Most foreign bodies (FBs) can spontaneously pass through the gastrointestinal tract. Sharp FBs are believed to be able to puncture any part of the gastrointestinal tract, causing perforation and potentially secondary damage to adjacent organs.

Case description

A 44-year-old man complained of having persistent dull pain in the perianal region. He was diagnosed with a toothpick impacted into the wall of the lower rectum after accepting a digital rectal examination of the lower rectum and a pelvic computed tomography (CT). The surgeon extracted the FB using vascular forceps guided by the operator's index finger. The patient was discharged after intravenous ceftriaxone was given for 6 days. A follow-up pelvic CT performed 2 weeks after surgery revealed that the perirectal fat and muscles had already normalized.

Conclusion

A systematic review of relevant literature from the past decade was performed to summarize the imaging features of an orally ingested toothpick perforating the gastrointestinal tract. The location of abdominal pain is an important clue for the diagnosis of toothpick perforation, and a CT examination is recommended as the first option for the detection of an ingested toothpick. Determining the location of the toothpick perforation and assessing the severity of local inflammation are important bases for the selection of treatment.

Accidentally ingested wooden toothpick, perforation of a sigmoid diverticulum and mimicking acute colonic diverticulitis: A case report and literature review

INTRODUCTION AND IMPORTANCE

Ingested wooden toothpick (WT) represents a rare cause of acute abdomen. Preoperative diagnosis of ingested WT is a challenge because of its unspecific clinical presentation, the low sensitivity rate of radiological investigations and the patient's inability to often recall the event of swallowing a WT. Surgery represents the main treatment in case of ingested WT-induced complications.

CASE PRESENTATION

A 72-year-old Caucasian male presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting and fever. Physical examination revealed LLQ abdominal pain and rebound tenderness with muscle guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography (CECT) showed colonic diverticulosis, wall thickening of the sigmoid colon, pericolic abscess, regional fatty infiltration, a suspicion of sigmoid perforation secondary to a foreign body. The patient underwent diagnostic laparoscopy: a sigmoid diverticular perforation caused by an ingested WT was noticed and a laparoscopic sigmoidectomy with end-to-end Knight-Griffen colorectal anastomosis, partial omentectomy and protective loop ileostomy were performed. The postoperative course was uneventful.

CLINICAL DISCUSSION

The ingestion of a WT represents a rare but potentially fatal condition which may cause GI perforation with peritonitis, abscesses and other rare complications if it migrates out of the GI tract.

CONCLUSION

Ingested WT may cause serious GI injuries with peritonitis, sepsis or death. Early diagnosis and treatment are crucial for reducing morbidity and mortality. Surgery is mandatory in case of ingested WT-induced GI perforation and peritonitis.

Laparoscopic treatment of right colic flexure perforation by an ingested wooden toothpick

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Ingested wooden toothpick.

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Laparoscopic suture.

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Sharp foreign bodies.

Introduction

Ingestion of a toothpick, both accidentally and intentionally, is a rare event.

Presentation of case

We present the case of a 42-years old man who was admitted to the emergency department at our Institution presenting with a 5-days history of right sided abdominal pain. Laboratory blood count reported leukocytosis and alteration of principal inflammation index; at the abdominal ultrasound no signs of perforation or collection were described.

Discussion

Indication to surgery was posed and an explorative laparoscopy was performed. The presence of local peritonitis at the right colonic flexure secondary to a full thickness bowel perforation caused by a toothpick was found. There was also an acute phlegmonous appendicitis. A laparoscopic appendectomy and a full-thickness double running suture of the perforation were performed.

Conclusion

Awareness about dangers of ingested toothpicks needs to be taken and the intestinal track/trace of the toothpick is mandatory until its expulsion.

Wooden toothpick partially embedded in the gastric antrum: a case report of an unusual finding in open access gastrointestinal endoscopy

Ingested toothpick is an unusual occurrence in clinical practice. This is a medical emergency and all effort should be made to localize the toothpick and appropriate intervention instituted. We report a case of accidentally ingested toothpick with successful endoscopic removal in a case of a 24year old male who presented for open access endoscopy with complaint of abdominal pain. During endoscopy a foreign body (sharp object) was seen partially embedded at the gastric antrum which was later identified as a wooden toothpick. Endoscopic removal was done using a Caesar grasping forceps (CGF-1-240). No complication was reported during and after the procedure. Ingested toothpick should be managed as an emergency in all cases and should be considered an important differential diagnosis in clients with complaint of abdominal pain especially in open access endoscopy.

Funding

None.

Successful diagnosis and treatment of ingested wooden toothpicks: Two case reports

RATIONALE

Foreign-body ingestion is a common phenomenon and foreign bodies are mostly excreted in stool. Once sharp bodies are ingested without being realized, perforation of intestine is possible and misdiagnosis may be made. We report 2 toothpick ingestion cases that were both diagnosed accurately.

PATIENT CONCERNS

We present 2 cases of middle-aged persons who suffered from abdominal pain. They did not realize and provide any information of having the history of swallowing foreign bodies.

DIAGNOSES

No serious problem was discovered in the examination and blood test. There were somewhere abnormal in computed tomography (CT) images and ultrasound (US). Then a toothpick was found penetrating the wall of intestine into the adjacent viscera in the laparotomy.

INTERVENTIONS

Both patients in the 2 cases were undergone operation to remove the toothpicks.

OUTCOMES

The 2 cases' prognoses were good.

LESSONS

When accepting patients with abdominal pain, suitable examining means and careful observation should be given to find easily ignored lesions. CT is recommended in the diagnostic process of swallowed foreign mass. When there is a vague place, US can be used for further diagnose.

Gastrointestinal perforation secondary to accidental ingestion of toothpicks: A series case report

RATIONALE

Toothpicks are widely used as a tooth cleaning tool after meals in China. Most of the Chinese toothpicks are made of wood or bamboo with a hard texture and sharp ends. This characteristic has proven to be potentially dangerous when toothpicks are accidentally ingested, as they can cause damage and perforation of the digestive tract and other subsequent complications.

PATIENT CONCERNS

The main clinical complaints of 5 patients in this study were mainly acute or chronic abdominal pain, duration from 2 days to 2 months, 1 case with vomiting, 1 case with fever.

DIAGNOSES

Four cases were initially diagnosed by computed tomography (CT) scan; However, the first case was misdiagnosed as appendicitis so the patient did not undertake a preoperative CT scan and it was diagnosed by laparoscopy.

INTERVENTIONS

All the cases were treated by laparoscopy and the toothpicks were removed successfully.

OUTCOMES

Toothpick-caused digestive perforation was confirmed by laparoscopy in all this 5 cases, the perforation sites were 2 cases at the antrum of stomach, 1 case at the third part of duodenum, 1 case at the ileocecal junction and 1 case at the sigmoid colon. 4 cases had perforation repair . Operative time :48-67 min. Intraoperative bleeding: 25-80 ml. 1 patient had a secondary liver injury. No postoperative complications occurred in all cases. The length of hospital stay was between 4-25 days.

LESSONS

Our case series study suggests that laparoscopy is a safe and feasible surgical procedure for definitive management of digestive tract perforation by toothpick ingestion. We also suggest all the people should have healthy life behaviors and use the toothpicks correctly.