A Toothpick a day, keeps the doctor away?
Journal | Volume 82 - 2019 |
Issue | Fasc.1 - Case reports |
Author(s) | L. Depoorter, T. Billiet, M. Verhamme, W. Van Moerkercke |
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(1) ASO Internal Medicine, UZLeuven ; (2) ASO Gastro-enterology, UZLeuven ; (3) Department of Gastro-enterology, AZ-Groeninge, Kortrijk, Belgium. |
A Toothpick is a dreaded offender when ingested, as it is risky to cause impaction, obstruction or perforation of the gut. When ingestion of a toothpick leads to one of these complications, it clinically mimics an acute abdomen. Often the patient doesn't recall the ingestion, leading to misdiagnosis as inflammatory bowel disease, appendicitis/diverticulitis, etc. We describe the case of a 50-year old woman presenting to the emergency department with right lower abdominal pain. CT-scan showed an obstruction without clear underlying cause. The hypothesis of obstruction due to intestinal adhesions without strangulation was assumed and non-operative management lead to recovery and dismissal of the patient. However, she presented 3 weeks later with identical complaints, this time showing a terminal ileitis on CT-scan. Surprisingly, a toothpick perforating the terminal ileum was found during endoscopy and could by removed. A clinician should think of foreign body ingestion when patients present with an acute abdomen with no clear underlying pathology. (Acta gastroenterol. belg., 2019, 82, 97-98). |
© Acta Gastro-Enterologica Belgica. PMID 30888762 |