Toothpick Colon Injury Mimicking Colonic Diverticulitis

Abstract

Although toothpick ingestion is rare, it can lead to fatal complications in the gastrointestinal tract. Diagnosing toothpick ingestion is difficult because most patients do not recall swallowing one. We report 2 cases of toothpick-ingestion-induced colon injury, mimicking diverticulitis. The first patient was a 47-year-old male who had received conservative treatment under the impression of his having diverticulitis in the cecum. Ultrasonography revealed a linear foreign body in the right lower abdomen; a subsequent laparoscopic examination revealed inflammation around the cecum, but no evidence of bowel perforation. A thorough investigation revealed a toothpick embedded in the subcutaneous fat and muscle layer of the lower abdominal wall; we removed it. The second patient was a 56-year-old male who had received conservative treatment under the impression of his having diverticulitis in the sigmoid colon. An explorative laparotomy revealed a toothpick piercing the sigmoid colon; we performed an anterior resection. Both patients were discharged without postoperative complications.

Perforation of the Terminal Ileum Secondary to Mucosal Damage of Enteroaggregative Escherichia coli and a Toothpick

“…Perforation by toothpick of the stomach, ileum, and sigmoid colon has been documented. Presentation of toothpick obstruction and perforation has been previously observed to mimic other conditions of the gastrointestinal tract, presenting initially as conditions such as acute appendicitis and colonic diverticulitis, which ultimately were perforations of the terminal ileum and colon, respectively [ 13 , 14 ]. Toothpick perforation of the stomach, with accompanying ulcerating gastritis of unknown origin, has been documented [ 15 ].…”

Toothpick perforates small bowel-mimicking diverticulitis

“…[ 2 ]. The timing of presentation varies significantly, where the majority of presentations are late (>2 weeks), owing to the inability of the patient to recall swallowing the FB and the time of the FB to induce symptoms [ 3 , 4 ]. The preferred investigation of choice is undetermined because most of the patients, if not all, will not recall ingesting a FB, or because of lack of clear history due to the patient’s factors; therefore, a formal workup of abdominal pain initially with an abdominal X-ray is required, which rarely detects the presence of FB, abdominal CT which has high sensitivity in detected FB if radiopaque, and no oral contrast to obscure the bowel lumen [ 5 , 6 ].…”