Toothpick impaction in a sigmoid diverticulum

A 70-year-old woman presented to our emergency department with recurrent episodes of left lower quadrant pain. She subsequently underwent high anterior resection with working diagnosis of acute diverticulitis, but intraoperatively was found to have perforated sigmoid diverticulum due to toothpick impaction. A high index of suspicion is required for diagnosis of toothpick ingestion. Appropriate preoperative investigations such as endoscopy and CT, despite their fairly low sensitivity, should be performed to increase the ability to accurately diagnose this condition and therefore optimise subsequent management.