Accidentally ingested wooden toothpick, perforation of a sigmoid diverticulum and mimicking acute colonic diverticulitis: A case report and literature review

• Published in: International journal of surgery case reports Vol. 104; p. 107945
• Main Authors: Evola, Giuseppe, Impellizzeri, Giulia, Pulvirenti, Elia, D'Angelo, Maria, Reina, Martina, Reina, Giuseppe Angelo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-03-2023; Elsevier
• Subjects: Acute abdomen; Case Report; Emergency surgery; Gastrointestinal perforation; Ingested foreign bodies; Wooden toothpick; Acute abdomen; Ingested foreign bodies; Case report; Gastrointestinal perforation; Emergency surgery; Wooden toothpick
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.107945

Ingested wooden toothpick (WT) represents a rare cause of acute abdomen. Preoperative diagnosis of ingested WT is a challenge because of its unspecific clinical presentation, the low sensitivity rate of radiological investigations and the patient's inability to often recall the event of swallowing a WT. Surgery represents the main treatment in case of ingested WT-induced complications.
A 72-year-old Caucasian male presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting and fever. Physical examination revealed LLQ abdominal pain and rebound tenderness with muscle guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography (CECT) showed colonic diverticulosis, wall thickening of the sigmoid colon, pericolic abscess, regional fatty infiltration, a suspicion of sigmoid perforation secondary to a foreign body. The patient underwent diagnostic laparoscopy: a sigmoid diverticular perforation caused by an ingested WT was noticed and a laparoscopic sigmoidectomy with end-to-end Knight-Griffen colorectal anastomosis, partial omentectomy and protective loop ileostomy were performed. The postoperative course was uneventful.
The ingestion of a WT represents a rare but potentially fatal condition which may cause GI perforation with peritonitis, abscesses and other rare complications if it migrates out of the GI tract.
Ingested WT may cause serious GI injuries with peritonitis, sepsis or death. Early diagnosis and treatment are crucial for reducing morbidity and mortality. Surgery is mandatory in case of ingested WT-induced GI perforation and peritonitis.
•A wooden toothpick (WT)-induced perforation of a sigmoid diverticulum is a rare cause of acute abdomen.•Diagnosis of WT-induced gastrointestinal (GI) perforation is a challenge because of the absence of specific clinical presentation.•WT impaction can be difficult to diagnose through radiology.•Radiology plays an important role in the diagnosis of WT-induced GI perforation•Surgery represents the main treatment in case of WT-induced open GI perforation and peritonitis.