Small Bowel Perforation by a Toothpick: A Case Report and Literature Review

• Published in: Dr. Sulaiman Al Habib medical journal 2024-07, Vol.6 (3), p.142-144
• Main Authors: Al-Darwish, Abdullah S., Akram, Hammad, Alsayyari, Tarfah, Arafeh, Fadi M., Alsaleh, Nuha A.
• Format: Article
• Language: English
• ISSN: 2666-819X; 2590-3349
• DOI: 10.4103/DSHMJ.DSHMJ_23_24

This case report and literature review present a rare case of small bowel perforation caused by an accidental ingestion of a toothpick. The patient’s subtle presentation with nonspecific symptoms posed diagnostic challenges, emphasizing the need for a high index of suspicion for foreign body ingestion in similar clinical scenarios. A 17-year-old male presented to the emergency department with a long history of abdominal pain, which had worsened over the past three days and localized to the right iliac fossa. The initial suspicion was acute appendicitis; however, an abdominal CT scan revealed a toothpick penetrating the small bowel wall. The patient underwent a diagnostic laparoscopy, during which the toothpick was removed and the perforated segment of the bowel was sutured intracorporeally. The patient had an uneventful postoperative recovery course and was discharged on the third postoperative day. Toothpick perforation poses diagnostic challenges due to its subtle presentation and lack of recollection of ingestion. Imaging plays a crucial role in identifying the foreign body and guiding appropriate treatment. Prompt surgical management involving removal of the foreign body and repair of the perforation is recommended, as nonoperative approaches generally have poor outcomes. Laparotomy or diagnostic laparoscopy is the most common and effective treatment depending on surgical experience and availability. Resection of the affected bowel segment may be required in cases of significant inflammation or large perforations. Overall prognosis is good with early diagnosis and intervention. This case emphasizes the importance of maintaining a high index of suspicion for perforations caused by sharp foreign bodies in patients with cryptogenic intra-abdominal pathology. A thorough history, physical examination, imaging studies, and timely surgery are crucial in preventing morbidity and mortality. Increased awareness of this rare but dangerous complication can lead to improved patient outcomes.