Gastrointestinal perforation secondary to accidental ingestion of toothpicks

Abstract

Rationale:Toothpicks are widely used as a tooth cleaning tool after meals in China. Most of the Chinese toothpicks are made of wood or bamboo with a hard texture and sharp ends. This characteristic has proven to be potentially dangerous when toothpicks are accidentally ingested, as they can cause damage and perforation of the digestive tract and other subsequent complications.Patient concerns:The main clinical complaints of 5 patients in this study were mainly acute or chronic abdominal pain, duration from 2 days to 2 months, 1 case with vomiting, 1 case with fever.Diagnoses:Four cases were initially diagnosed by computed tomography (CT) scan; However, the first case was misdiagnosed as appendicitis so the patient did not undertake a preoperative CT scan and it was diagnosed by laparoscopy.Interventions:All the cases were treated by laparoscopy and the toothpicks were removed successfully.Outcomes:Toothpick-caused digestive perforation was confirmed by laparoscopy in all this 5 cases, the perforation sites were 2 cases at the antrum of stomach, 1 case at the third part of duodenum, 1 case at the ileocecal junction and 1 case at the sigmoid colon. 4 cases had perforation repair . Operative time :48-67 min. Intraoperative bleeding: 25-80 ml. 1 patient had a secondary liver injury. No postoperative complications occurred in all cases. The length of hospital stay was between 4-25 days.Lessons:Our case series study suggests that laparoscopy is a safe and feasible surgical procedure for definitive management of digestive tract perforation by toothpick ingestion. We also suggest all the people should have healthy life behaviors and use the toothpicks correctly.

Ingested toothpick retrieved through a lumbar approach: a case report

“…According to the Management of ingested foreign bodies and food impactions which recommended by the American Society for Gastrointestinal Endoscopy (ASGE) in 2011 [4], sharp foreign bodies reaching the stomach or proximal duodenum should be retrieved endoscopically if possible, and surgical intervention should be considered for objects that fail to progress within 3 days confirmed by a daily-radiograph. In previous reports, toothpicks that required surgical intervention often retrieved through exploratory laparotomy or laparoscopic exploration surgery under general anesthesia [5,6]. To our best knowledge, this is the first case that removing an ingested toothpick through a lumbar surgical approach under local anesthesia, by which the patient gained less trauma, less use of analgesics, less hospital stay and less hospital expenses.…”

“…In our case, the patient had a course up to more than 20 days, physical examination did not show the signs of peritonitis, and the relevant auxiliary examination suggested that the toothpick had been fixed with one of its ends close to the right flank surface, the inflammatory indicators suggested a non-inflammatory acute phase, indicating that perforation has been limited. Severe locally inflammatory edema, adhesion, or fibrous wrappage might occur at the area of perforation simultaneously [6,7], these make an abdominal surgery (laparotomy or laparoscopic surgery) rather difficult. Sometimes an intestinal resection surgery should be arranged followed by the removal of the foreign bodies [5], resulting in a relatively large surgical trauma and potential abdominal contamination.…”

A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

“…Although an emergency laparotomy appears to be the most common therapeutic intervention in cases of proven perforation and generalised peritonism,9 Yang et al demonstrated a successful laparoscopic approach, with removal of the offending body 3. Furthermore, in a case series of five patients, all of whom had complications arising from ingested fish bones, Chia et al demonstrated successful laparoscopic removal in all cases and repair of three gastric perforations with intracorporeal suturing 4.…”

“…This is often diagnosed via CT scan as patients rarely recollect accidental ingestion. Management is typically via laparotomy although case series have demonstrated the merits of a laparoscopic approach 1 3 4…”

Resultados del Tratamiento Quirúrgico de la Perforación Intestinal Causada por Ingestión de Mondadientes. Aportación de 3 Casos

“…Los CE ingeridos rara vez se detectan por radiología convencional, porque suelen ser de dimensiones pequeñas y baja radiopacidad (Yang et al, 2017;Lim et al); así como porque a menudo están ocultos por gas intestinal. En un estudio de 358 pacientes que habían ingerido una espina de pescado, la radiología convencional tuvo una sensibilidad de 32% (Ngan et al, 1990).…”