Dual site intestinal perforation due to toothpick

Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Foreign body ingestion can lead to gastrointestinal perforation, often presenting with non-specific symptoms.
• Misdiagnosis is common, with conditions like appendicitis or diverticulitis frequently suspected.
• The distal ileum and recto-sigmoid colon are high-risk areas for impaction and perforation.

Observation:

• A 45-year-old male presented with abdominal pain and fever, initially suspected as acute appendicitis.
• Diagnostic laparoscopy revealed a toothpick perforating both the sigmoid colon and small bowel.
• The toothpick was removed, and the perforations were surgically sutured without complications.

Findings:

• Intraoperative diagnosis of toothpick perforation in both large and small bowel.
• Successful surgical management with direct suture repair of the perforations.
• Uncomplicated recovery following a 5-day course of intravenous antibiotics.

Implications:

• This case underscores the importance of considering foreign body ingestion in the differential diagnosis of acute abdominal conditions.
• CT scans offer higher diagnostic yield for detecting radio-opaque foreign bodies compared to X-rays.
• Standardized management guidelines for lower gastrointestinal foreign bodies are lacking, necessitating case-by-case decision-making.