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A Toothpick a day, keeps the doctor away?
L Depoorter1, T Billiet2, M Verhamme3
1ASO Internal Medicine, UZLeuven.
Acta Gastro-Enterologica Belgica
|March 20, 2019
Summary
Toothpick ingestion can cause serious gastrointestinal issues like obstruction or perforation, mimicking acute abdominal conditions. Clinicians should consider foreign body ingestion in unexplained acute abdomen cases, as illustrated by a patient with a perforated toothpick.
Area of Science:
- Gastroenterology
- Surgical Case Reports
Background:
- Ingested foreign bodies, particularly toothpicks, pose a significant risk for gastrointestinal impaction, obstruction, and perforation.
- Such complications often present as acute abdomen, frequently leading to misdiagnosis due to lack of recalled ingestion history.
Observation:
- A 50-year-old woman presented with right lower abdominal pain, initially diagnosed as intestinal adhesions after CT scan showed obstruction.
- Non-operative management led to initial recovery, but she returned weeks later with similar symptoms and CT-confirmed terminal ileitis.
Findings:
- Endoscopic examination revealed a toothpick perforating the terminal ileum, which was subsequently removed.
- This case highlights the diagnostic challenge posed by toothpick ingestion in acute abdominal presentations.
Implications:
- Clinicians must maintain a high index of suspicion for foreign body ingestion in patients presenting with acute abdomen of unclear etiology.
- Prompt diagnosis and removal of ingested foreign bodies are crucial to prevent severe gastrointestinal complications.
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