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Proximal jejunal perforation by an ingested toothpick: a rare case report
Ghazi Lâamiri1, Jasser Rchidi1, Hazem Beji1
1Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia.
Introduction:
Toothpick ingestion is a rare event that may cause gastrointestinal perforation, abscess, or peritonitis. Jejunal involvement is exceptionally uncommon.
Case Presentation:
A 45-year-old man, previously operated on for appendicular peritonitis, presented with generalized abdominal pain and vomiting. A CT scan revealed pneumoperitoneum with a linear foreign body perforating the proximal jejunum. Laparoscopy showed diffuse peritonitis and a toothpick perforating the antimesenteric border 70 cm from the duodenojejunal flexure. Conversion to laparotomy was required because of adhesions and contamination. The toothpick was extracted, and primary repair with lavage and drainage was performed. The postoperative course was uneventful, with discharge on day 4.
Discussion:
Jejunal perforation by an ingested toothpick is exceedingly rare and often misdiagnosed. CT remains the most reliable diagnostic tool despite the radiolucent nature of wood. Early surgery is crucial to avoid sepsis.
Conclusion:
Prompt recognition and surgical management ensure excellent outcomes.