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Qi Q, Chen L, Kou G. Sepsis due to kidney injury caused by a toothpick: a case report and literature review. BMC Infect Dis 2022; 22:115. [PMID: 35109820 PMCID: PMC8811973 DOI: 10.1186/s12879-022-07058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Toothpicks are common foreign bodies which may injure surrounding organs leading to a series of atypical symptoms. We present a rare clinical case that septicemia caused by a toothpick penetrated into the right kidney. CASE PRESENTATION We describe a 51-year-old patient who presented with right-sided backache and hematuresis for 2 days. Blood culture persistently grew Streptococcus gordonii. Ultrasound of the patient's urinary tract revealed a strong striated echo in the middle of the right kidney. Complete abdominal computed tomography revealed a duodenal foreign body penetrating into the right kidney. The toothpick was removed under endoscopy and hemostasis was given. Antibiotic treatment was upgraded. The patient was recovered and discharged from his stay on the fifteenth day. CONCLUSIONS Early identification of the etiology of sepsis can effectively alleviate patient's distress and reduce hospital stay. Clinicians should identify the source of sepsis through a medical history and examination.
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Affiliation(s)
- Qi Qi
- The Infection Department of Mianyang Central Hospital, Mianyang, 621000, China
| | - Lingxin Chen
- The Infection Department of Mianyang Central Hospital, Mianyang, 621000, China
| | - Guoxian Kou
- The Infection Department of Mianyang Central Hospital, Mianyang, 621000, China.
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Sablone S, Lagouvardou E, Cazzato G, Carravetta F, Maselli R, Merlanti F, Bavaro DF, De Donno A, Introna F, Caputi Iambrenghi O. Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010131. [PMID: 35056439 PMCID: PMC8780250 DOI: 10.3390/medicina58010131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.
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Affiliation(s)
- Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
- Correspondence: or
| | - Elpiniki Lagouvardou
- Section of General Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (E.L.); (O.C.I.)
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari, 70124 Bari, Italy;
| | - Francesco Carravetta
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Roberto Maselli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Francesco Merlanti
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Davide Fiore Bavaro
- Section of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy;
| | - Antonio De Donno
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Francesco Introna
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Onofrio Caputi Iambrenghi
- Section of General Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (E.L.); (O.C.I.)
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Hu K, McGwin G. Toothpick-related injuries in the United States from 2001 to 2017. Int J Inj Contr Saf Promot 2021; 28:387-391. [PMID: 34058946 DOI: 10.1080/17457300.2021.1930059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kaili Hu
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Ophthalmology, University of Alabama at Birmingham, Callahan Eye Hospital, Birmingham, AL, USA
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Herzwurm ZP, Murphy CS, Griswold BG, Webber CRJ, Mahoney KM. From Lateral Ankle Sprain to Above-Knee Amputation: A Unique Case Report of Group A Streptococcus Necrotizing Soft-tissue Infection. J Orthop Case Rep 2020; 10:52-55. [PMID: 34169017 PMCID: PMC8046446 DOI: 10.13107/jocr.2020.v10.i09.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Necrotizing fasciitis, also referred to necrotizing soft-tissue infection (NSTI), is an infrequent entity that results in orthopedic consultation. It is a rapidly spreading typically associated with a contaminated wound that spreads rapidly along fascial planes resulting in significant morbidity and mortality. However, it is a rare occurrence that such pathology occurs in an atraumatic fashion, which is without a wound through the skin. Case Report: A 33-year-old female with no significant medical history presented to a walk-in orthopedic clinic with increasing ankle pain after a lateral ankle sprain 2 days prior. Patient denies any fevers, chills, shortness of breath, numbness, tingling, paresthesia, or any additional trauma since the initial ankle sprain. The patient was afebrile, maintaining oxygenation, normotensive, but tachycardic to just over 100. Physical examination was only significant for moderate swelling and ecchymosis about the lateral malleolus. X-rays and venous ultrasound were negative for any associated pathology. After a period of observation, the patient acutely decompensated with a significant increase in pain in the lower leg on passive stretch, an increase in compartment firmness and a worsening tachycardia up to the 120’s. The patient was taken emergently for fasciotomies for presumed compartment syndrome. The patient was hemodynamically unstable during the case and transferred to the intensive care unit where she continued to decompensate, requiring multiple vasopressors. The affected extremity became necrotic at the level of the foot and her hemodynamic instability continued, causing a return to the operating room for an emergent guillotine above-knee amputation. The patient progressively stabilized and underwent a formal above-knee amputation 2 days later. Cultures obtained during the second case were positive for Group A Streptococcus. Conclusion: This case highlights the variable presentation of NSTIs as well as has having a high index of suspicion to ensure this highly morbid and fatal disease process is diagnosed expeditiously. This case is also unique in that it developed without any obvious wounds and that monomicrobial Group A Streptococcus was the culprit, while most NSTIs are polymicrobial.
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Affiliation(s)
- Zachary P Herzwurm
- Department of Orthopaedic Surgery, Augusta University Medical Office Building, Augusta, Georgia
| | - Cameron S Murphy
- Department of Orthopaedic Surgery, Augusta University Medical Office Building, Augusta, Georgia
| | - B Gage Griswold
- Department of Orthopaedic Surgery, Augusta University Medical Office Building, Augusta, Georgia
| | - Colton R J Webber
- Department of Orthopaedic Surgery, Augusta University Medical Office Building, Augusta, Georgia
| | - Kyle M Mahoney
- Department of Orthopaedic Surgery, Augusta University Medical Office Building, Augusta, Georgia
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Necrotizing fasciitis from an iliopsoas muscle abscess caused by a toothpick: A case report and literature review. Int J Surg Case Rep 2020; 76:463-467. [PMID: 33207411 PMCID: PMC7586045 DOI: 10.1016/j.ijscr.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022] Open
Abstract
Ingested toothpick caused gut injury are a rare event, but caused retroperitoneal infection are relatively rare. The diagnosis of psoas abscesses associated with toothpicks is challenging and should not be overlooked. Gastrointestinal symptoms are uncommon when the gut perforation site is over the retroperitoneal space. 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.
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