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Zhang X, Xing M, Lei S, Li W, Li Z, Xie Y, Zhu C, Zhang S. Case report and literature review: Orally ingested toothpick perforating the lower rectum. Front Surg 2024; 11:1368762. [PMID: 38435079 PMCID: PMC10904550 DOI: 10.3389/fsurg.2024.1368762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
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.
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Affiliation(s)
- Xingliang Zhang
- Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mei Xing
- Department of Radiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shaoyang Lei
- Department of Radiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wentao Li
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zijin Li
- Department of Radiology, Yuebei People’s Hospital, Shaoguan, Guangdong, China
| | - Yibing Xie
- Department of Graduate School, Hebei North University, Zhangjiakou, Hebei, China
| | - Chenyu Zhu
- Department of Graduate School, North China University of Science and Technology, Hebei, China
| | - Shuqian Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Fallatah AA, Mashbari H, Daghestani H, Mostafa O, Alshahwan N, Alburakan A, Nouh T. Toothpick perforates small bowel-mimicking diverticulitis. J Surg Case Rep 2023; 2023:rjad511. [PMID: 37727225 PMCID: PMC10506890 DOI: 10.1093/jscr/rjad511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
Bowel perforation is an emergency condition that requires critical thinking and readily intervention; nevertheless, on occasions, its presentation can be challenging to diagnose. Several etiologies could cause bowel perforation, including obstruction, mass, inflammation, ischemia, etc. On rare occasions, a foreign body could be the cause of perforation, which mandates a detailed history and focused review of the images when the patient's condition allows. We report a case of ileal perforation caused by an ingested wooden toothpick that was suspected on the CT images, which the patient has no memory of ingesting.
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Affiliation(s)
- Ahmed A Fallatah
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
- General Surgery Section, Department of Surgery, King Abdulaziz Hospital, Ministry of Health, P.O Box 3665 Jeddah 22421, Saudi Arabia
| | - Hassan Mashbari
- Department of Surgery, Faculty of Medicine, Jazan University, P.O Box 6809 Jazan 82817-28204, Saudi Arabia
| | - Hatoon Daghestani
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Omar Mostafa
- College of Medicine, Sulaiman Al Rajhi University, P.O Box 777 Albukairiyah 51941, Saudi Arabia
| | - Nawaf Alshahwan
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Ahmed Alburakan
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
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Rezende SM, Furlan BB, Bernardino TCDS. Wooden Toothpick and Pancreatitis. Am J Med 2023; 136:e3-e4. [PMID: 36154813 DOI: 10.1016/j.amjmed.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Suely Meireles Rezende
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Bruno Bom Furlan
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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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Lu YL, Hu J, Zhang LY, Cen XY, Yang DH, Yu AY. Duodenal perforation after organophosphorus poisoning: A case report. World J Clin Cases 2021; 9:8186-8191. [PMID: 34621879 PMCID: PMC8462211 DOI: 10.12998/wjcc.v9.i27.8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Organophosphorus poisoning (OP) is one of the common critical conditions in emergency departments in China, which is usually caused by suicide by taking oral drugs. Patients with severe OP have disturbance of consciousness, respiratory failure, toxic shock, gastrointestinal dysfunction, and so on. As far as we know, the perforation of the duodenum caused by OP has not been reported yet.
CASE SUMMARY A 33-year-old male patient suffered from acute severe OP, associated with abdominal pain. Multiple computed tomography scans of the upper abdomen showed no evidence of intestinal perforation. However, retrograde digital subtraction angiography, performed via an abdominal drainage tube, revealed duodenal perforation. After conservative treatment, the symptoms eased and the patient was discharged from hospital.
CONCLUSION Clinicians should pay close attention to gastrointestinal dysfunction and abdominal signs in patients with severe OP. If clinical manifestation and vital signs cannot be explained by common complications, stress duodenal ulcer or perforation should be highly suspected.
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Affiliation(s)
- Yuan-Lan Lu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Jie Hu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Lu-Ying Zhang
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiang-Yin Cen
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Deng-Hui Yang
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - An-Yong Yu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Laparoscopic treatment of right colic flexure perforation by an ingested wooden toothpick. Int J Surg Case Rep 2020; 77S:S109-S111. [PMID: 32958447 PMCID: PMC7876685 DOI: 10.1016/j.ijscr.2020.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022] Open
Abstract
Ingested wooden toothpick. Laparoscopic suture. 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.
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Gheorghiu MI, Bolliet M, David P, Denis B. Case report of abdominal left upper quadrant collection secondary to fish bone perforation. Med Pharm Rep 2020; 93:301-305. [PMID: 32832897 PMCID: PMC7418842 DOI: 10.15386/mpr-1429] [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: 07/24/2019] [Revised: 09/25/2019] [Accepted: 01/22/2020] [Indexed: 11/23/2022] Open
Abstract
We present an unusual case of an intra-abdominal collection which evidenced a rare etiology and raises diagnostic particularities. Background Fish bones ingestion is frequent, but seldom followed by complications. Those are often reported at specific sites. Objectives This case report emphasizes the unusual presentation and site localization of a colonic perforation by a small fish bone, in the context of limited radiological accuracy at the diagnostic phase. Case presentation A 37 year old male was admitted to the gastroenterology ward with upper and left sided abdominal pain associated with fever and marked fatigue. His medical history was marked by a sleeve gastrectomy in 2010 for obesity. Abdominal signs and elevated acute inflammatory syndrome on blood tests were followed by computer tomography which revealed a pericolic mass near the left splenic flexure. The pain and fever increased in intensity, so a laparotomy was proposed. Intraoperatively, a tumor-like lesion was found and a resection with oncologic limits was performed. Microscopic examination of the specimen revealed a fish bone, but only after surgery did the patient confirm that he had eaten fish meal the week before. The post-operative period was uneventful. Conclusion Fish bones remain some of the most frequently ingested alimentary foreign bodies; they may cause atypical clinical presentations, frequently omitted by the patients themselves if symptoms appear delayed. They could also lead to possible high-risk complications which need to be addressed by surgeons.
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Ling CR, Chen Y, He CG. Ingested toothpick retrieved through a lumbar approach: a case report. BMC Surg 2020; 20:99. [PMID: 32398146 PMCID: PMC7216533 DOI: 10.1186/s12893-020-00768-x] [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: 02/26/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ingested toothpick may cause severe complications if there is no intervention timely. Toothpicks that required surgical intervention often retrieved through exploratory laparotomy or laparoscopic exploration surgery under general anesthesia, while, those through lumbar approach have been rarely reported. Herein, authors report a case of ingested toothpick which removed through the lumbar surgical approach under local anesthesia and the patient has gained a considerable recovery. Case presentation A 57-year-old man was admitted to our hospital with distending pain in the right flank for more than 20 days. He had a history of accidental toothpick ingestion. Abdominal computed tomography (CT) scan and Color Doppler Ultrasound of the superficial tissue (right flank pain area) consistently revealed a linear lesion -corresponding to the toothpick- was located at the right flank next to the body surface. Surgery via lumbar approach was then successfully performed to retrieve the toothpick under local anesthesia. The post-procedural course was uneventful, and the patient was discharged on the third day after surgery, no complications were noted at the 18-month follow-up. Conclusion When a foreign body that causes perforation of the digestive tract remains for a relative long time (non-acute stage) and the perforation is close to the body surface, a local anesthesia surgery through the corresponding body surface may be a considerable choice.
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Affiliation(s)
- Chun-Run Ling
- Department of General and Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Tao Yuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi Chen
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Chun-Gang He
- Department of General and Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Tao Yuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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Ozen O, Torun E, Yuksel Y, Ergun T, Basaran I. Perforation of terminal ileum by a toothpick. Br J Hosp Med (Lond) 2020; 81:1-2. [PMID: 32468941 DOI: 10.12968/hmed.2020.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ozkan Ozen
- Department of Radiology, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Ebru Torun
- Department of Radiology, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Yavuz Yuksel
- Department of Radiology, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Tarkan Ergun
- Department of Radiology, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Ismail Basaran
- Department of Pediatric Surgery, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Brown AJ, Whitehead-Clarke T, Tudyka V. A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart. BMJ Case Rep 2019; 12:12/5/e228050. [PMID: 31092482 DOI: 10.1136/bcr-2018-228050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!
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Affiliation(s)
- Andrew James Brown
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK
| | | | - Vera Tudyka
- General Surgery, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK
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Zhao Y, Yang Z, Quan J, Hu H. Sonographic diagnosis of perforation of the gastric antrum caused by a foreign body: A case report. Medicine (Baltimore) 2019; 98:e14586. [PMID: 30813179 PMCID: PMC6408005 DOI: 10.1097/md.0000000000014586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Ingestion of foreign bodies often occurs in clinical environments, especially in toddlers and aged patients. Although plain radiography and CT are widely used for the assessment of foreign bodies, sonography has an advantage in the diagnosis of some radiolucent foreign bodies, such as wood and bamboo materials. PATIENT CONCERNS An 80-year-old woman presented with a 4-day history of right upper quadrant abdominal persistent distended pain without radiation. DIAGNOSES Radiographs, a preliminary abdominal ultrasound (US) and an abdominal computed tomography (CT) were unremarkable. A repeat abdominal US found a foreign body inserted in the gastric wall of antrum. But subsequent gastroscopy was negative. A laparotomy confirmed the diagnosis of bamboo stem penetration out of the gastric antrum. INTERVENTIONS The patient was treated by laparotomy and the bamboo stem was removed successfully. OUTCOMES Bamboo stem-caused digestive perforation was confirmed by laparotomy. The perforation site was at the gastric wall of antrum. Intravenous antibiotic therapy was administered for two weeks until her body temperature dropped to a normal level, and C-reactive protein (CRP) decreased to the normal limits. she was discharged from the hospital. LESSONS Previous studies suggest that US can identify the location and shape of foreign bodies in the alimentary tract in toddlers. This case shows US is also effective in aged patients. The US can be utilized as a problem-solving tool when radiolucent foreign bodies are suspected, especially when the results of CT and gastroscopy are negative.
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Affiliation(s)
- Yanan Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Zheng Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Juan Quan
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Huisen Hu
- Department of Ultrasound, Lanxi People's Hospital, Jinhua, Zhejiang, China
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