Perforation of the cecum by a toothpick: report of a case and review of the literature.

Zouros, Efstratios; Oikonomou, Dimitrios; Theoharis, Georgios; Bantias, Christos; Papadimitropoulos, Konstantinos

BACKGROUND Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully and rarely cause complications. However, long, sharp, slender, and hard objects such as fish bones, chicken bones, and toothpicks may lead to perforation of the GI tract, which is a potentially life-threatening complication. CASE REPORT We report the case of a 50-year-old woman who presented to the Emergency Department of our hospital complaining of right lower quadrant abdominal pain of 2 days' duration. Ultrasound imaging and computed tomography scan demonstrated the presence of a foreign body protruding from the lateral cecal wall and surrounded by an area of inflammation. The patient was taken to the operating room, where a toothpick was found to have perforated the cecum. The FB was removed and the defect of the intestinal wall was closed using a TA linear stapler (Covidien, Mansfield, MA). The patient was discharged on the 8(th) postoperative day. We also conducted a literature search for reports on injuries caused by ingested FBs. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Perforation of the GI tract by an ingested FB in the adult population is most commonly secondary to accidental ingestion. Patients rarely recall the episode of the ingestion, or may remember the incident only after a diagnosis is made. We present this case to increase awareness of the diagnosis.