Acute abdominal pain complicated by cecal perforation caused by an unnoticed swallowed toothpick: A case report

Acute abdominal pain is one of the most common gastrointestinal symptoms. The etiology of acute abdomen can be challenging for gastroenterologists to establish. Cecal foreign body is a rare cause of cecal perforation.

We report a 35-year-old male from China who initially exhibited symptoms suggestive of acute appendicitis. However, during a minimally invasive colonoscopy procedure, the authors found that a wooden toothpick caused the perforation. The patient presented to our emergency department with a 2 days history of right lower abdominal pain and low grade fever. The patient was in good health and had eaten fish 2 days earlier. Physical examination revealed mild pain with positive rebound tenderness in the right lower abdomen. However, computed tomography of the abdomen confirmed a strip of high-density shadows protruding beyond the intestinal cavity outline, with a small amount of peritoneal seepage in the ileocecal area. Combined with the medical history, the possibility of foreign body perforation by a fishbone and peripheral peritonitis were considered. However, the high-density shadow was identified as a wooden toothpick, which was removed via a minimally invasive procedure using a foreign body forceps under colonoscopy. The patient's condition improved significantly within 5 days after treatment.

We emphasize the importance of a detailed patient history, accurate diagnosis and proper treatment in patients with acute abdomen.