Answer to case of the month #150 right iliac fossa abscess secondary to cecal perforation by toothpick

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.

Toothpick injury mimicking acute cholecystitis

Introduction: Accidental foreign bodies ingestion is common in emergency department. However, if the objects are sharp, the complication rate is higher. Toothpick can cause severe complications of gastrointestinal tract due to being long, sharp ends on both sides, slender, and resistant to digestion. Case presentation: A 64-year-old man presented to the emergency department with fever and right upper abdominal pain for 3 days. The physical examination revealed severe pain with rebound tenderness in the right upper abdominal quadrant and positive Murphy’s sign. The provisional diagnosis of acute cholecystitis was made. The contrast abdominal-pelvic computed tomography scan revealed linear-shaped lesion penetrating hepatic flexure of colon and proximal transverse colon. The patient showed deterioration of vital sign, and therefore, emergency laparotomy was performed. Colon perforation by wooden toothpick was diagnosed. Discussion and conclusion: Toothpick ingestion without awareness is rare but fatal, especially when physicians failed to suspect foreign body ingestion. We think of this as one of the differential diagnoses, so we use contrast computed tomography scan.

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

Perforation of the splenic flexure of the colon by an ingested wooden toothpick

We present the case of a 23-year-old man who consulted in the emergency department 6 days after ingesting a wooden toothpick with features of a localized peritonitis in the left upper quadrant of the abdomen. Surgical exploration revealed a perforation of the splenic flexure of the colon by the toothpick during its migration. This rare case is analysed in the light of the current literature. There is need for a greater awareness about the dangers of a swallowed toothpick. It is advisable to always trace the toothpick until it is found or expelled.

Uncommon causes of acute abdominal pain: multidetector computed tomography pearls and pitfalls for the radiologist on call

We review uncommon causes of acute abdominal pain in which inconclusive multidetector computed tomography (MDCT) studies were followed by emergency surgery and unexpected diagnoses. Despite dedicated protocols and technical advances, MDCT of uncommon causes of acute abdominal pain still represents a significant challenge for the radiologist on call. We emphasize diagnostic pearls and pitfalls that may help the radiologist on call identify or suspect these uncommon causes of acute abdominal pain on MDCT.