Computed Tomographic Detection of Toothpick Perforation of the Jejunum: Case Report and Review of the Literature

Abstract

Foreign body ingestion is commonly encountered in the emergency department. Although in most cases, the ingested object will pass uneventfully in the feces [1], ingestion of sharp foreign bodies such as dental plates, sewing needles, toothpicks, fish bones and chicken bones carries increased risk of gastrointestinal perforation [2, 3, 4].The use of toothpicks as both tooth-clearing implements and eating utensils increase the likelihood of toothpick unintentional ingestion [5].Toothpicks account for 9% of reported foreign bodies ingested [6]. These pointed wooden bodies when accidentally swallowed are associated with higher risk of complications, such as gastric, small bowel or colonic perforation, obstruction, colonic impaction, gastrointestinal bleeding, subphrenic abscess, fistula formation, sepsis and/or death due to the damaged caused by the sharp pointed ends [7, 8, 9].Unfortunately, many patients who ingested such objects fail to remember the mis-swallowing event when symptoms of perforation develop, making diagnosis problematic.We present a case of jejunal perforation secondary to an ingested wooden toothpick correctly diagnosed with Computed Tomography (CT).

Bacteremia Associated With a Toothpick Lodged in the Duodenal Wall

“…Definitive diagnosis can be made by explorative laparotomy [ 17 ], but it is rather an invasive procedure and assessment of objects lodged in the upper and lower GI tract. Gastroduodenoscopy and colonoscopy are the preferred choices because of their ability to visualize the area involved [ 18 ].…”

Toothpick—a rare cause of bowel perforation: case report and literature review

“…Abdominal radiography may detect free-air in peritoneal cavity. However, toothpicks may be invisible on radiography due to the nonradiopaque nature of wood [12] . Ultrasound can identify the location of inflamed bowels or abscesses, abdominal free-air, or fluid collection.…”

Radiological diagnosis of a small bowel perforation secondary to toothpick ingestion

“…However, ingestion of a toothpick carries a greater risk of perforation and internal organ injury than other foreign bodies due to its pointed shape 1 11 12. Toothpicks can often be ingested with the patient being unaware or failing to disclose such information on initial admission to hospital.…”

“…Ingestion of a foreign body is a common presentation to the emergency department and surgical take 1. Toothpick ingestion carries a greater risk of perforation due to its sharp points, when compared with less barbed foreign objects and can cause a wide variety of intra-abdominal and mediastinal injury 2–8.…”

“…Toothpick ingestion carries a greater risk of perforation due to its sharp points, when compared with less barbed foreign objects and can cause a wide variety of intra-abdominal and mediastinal injury 2–8. In the setting of poor palatal sensation, due to dentures, patients may lack a significant corroborative history of toothpick ingestion and as a result reported diagnostic modalities have ranged from plain abdominal X-ray to small bowel series,6 ultrasound scan,9 CT scan1 and endoscopy 10. The majority of patients with knowledge of toothpick ingestion will come to no adverse effect with the offending object passing without internal injury.…”