Accidentally ingested wooden toothpick, perforation of a sigmoid diverticulum and mimicking acute colonic diverticulitis: A case report and literature review

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 ].…”

“…Further, it can detect associated complications such as perforation, abscess, inflammatory process, etc. [ 3 ].…”

“…The success rate of retrieval increases within the first 24 hours of ingestion [ 9 , 10 ]. When an asymptomatic patient has a FB in the lumen of the distal GI tract that has not yet caused complication, a watchful waiting for the FB to pass with bowel motions is acceptable, provided that the FB is not a battery or magnet [ 3 ]. Surgical intervention is mandated when complications occur, and the approach should be determined based on the patient’s overall condition and the surgeon’s experience [ 9 ].…”

“…Diagnostic laparoscopy is feasible and effective in diagnosing and managing FB complications. Furthermore, it can be utilized to establish a diagnosis and treat the cause of the patient’s symptoms and any present complications when the diagnosis is in doubt [ 3 ].…”