An early diagnosis of gastrointestinal perforation caused by a toothpick

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 8; pp. 1974 - 1978
• Main Authors: AMANO, Takahiro, NAGAOKA, Sakae, KAZAMA, Yoshihiro, SAKAI, Keisuke
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2012
• Subjects: intestinal perforation; swallowed foreign body; toothpick
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.1974

A 66-year-old Japanese woman required endoscopic removal of a sharp foreign body from the duodenum while in Indonesia. However, she continued to have a dull abdominal pain. After a month, she returned to Japan and was admitted to our hospital. On physical examination abdominal tenderness in the right lower quadrant without peritoneal irritation and a movable mass were found. A relationship between the abdominal pain and the patient's past history was considered. Abdominal plain computed tomography showed a high-density, linear object in the ileum ; the top part of the object penetrated the ileal wall and reached the mesentery. A gastrointestinal perforation and an inflammatory tumor caused by the linear foreign body were diagnosed. Based on the location and the form of the object, endoscopic removal was impossible, and a partial ileal resection was performed. The foreign body was found to be a toothpick. To diagnose gastrointestinal perforation caused by a foreign body, it is important to consider this as a possibility in the differential diagnosis of patients presenting a similar history. We report a case of gastrointestinal perforation caused by a toothpick which was diagnosed early based on the past history.