Intra-abdominal abscess caused by toothpick injury

Abstract

We present the case of a 42-year-old female who presented to our emergency department (ED) complaining of epigastric pain for four days. She had been seen in the outpatient department and ED previously for evaluation, but continued to experience epigastric pain with fever. Emergency panendoscopy was performed and a toothpick was discovered impacted in the duodenal bulb. The gastroenterologist was unable to remove the toothpick endoscopically. Computed tomography of the abdomen revealed a long and straight hyperdense foreign body, and intra-abdominal abscess formation. An emergency laparotomy was performed. The patient recovered gradually and was discharged 11 days later. She could not remember when she swallowed the wooden toothpick, but guessed that it was while out drinking. There is an old wives' tale in Taiwan that putting a toothpick in the cup while drinking beer reduces the likelihood of abdominal distention from the carbonation of the beer.

Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review

“…Fish bone [ 12 , 14 – 16 , 18 , 20 , 23 ] was the most common FB, followed by toothpicks [ 13 , 19 , 21 , 24 , 27 , 29 ]. Other uncommon types of FB included needles [ 17 , 25 ], blister packs [ 8 ], and wooden skewers [ 28 ].…”

“…Endoscopy can be used as both an examination tool and a treatment method. It is worth noting that in some cases, the patient’s results with a standard abdominal X-ray [ 15 , 18 , 19 ] or endoscopic examination were normal, but CT [ 15 – 17 ] examination revealed abnormalities. This is because if the FB is completely surrounded by the mucosa, only gastric mucosa edema and purulent external pressure can be seen under the endoscope.…”

“…The diagnostic tools included CT [8,12,13,[15][16][17][18][19][20][22][23][24][25][26][27], X-ray [14, 15, 18-21, 23-26, 28], ultrasonography [12,15,17,20,21,24,26,27], and endoscopy [14-17, 26, 29]. CT was used in almost every case.…”

A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

“…There are reported lot of cases of aorto-enteric, entero-caval, duodeno-renal fistula (10), perforation of Meckel's diverticulum (11), perforation of a colon diverticulum (12), pylephlebitis (13), hydronephrosis (14) due to a toothpick ingested perforating the gastro-intestinal wall. The most frequent consequences of the duodenum and in general of the gastrointestinal tract perforation are liver abscesses from toothpick migration in the liver; in other cases there are reports of abdominal wall abscesses (15) or abdominal abscesses (16). In literature case of perforation of the left colic flexure mimicking renal colic (17), and a case of thigh cellulites (18) and a subcutaneous emphysema of the leg secondary to toothpick ingestion (19) have been reported.…”

“…Also there is a reported case of right coronary perforation due to a toothpick ingested that had penetrated the gastric wall and subsequently migrated into the chest through the diaphragm (20) and a case of constrictive pericarditis due to toothpick that migrated into the pericardium (21). Accidental ingestion of toothpicks may cause symptoms mimicking Crohn's disease (22), acute appendicitis (23,24) and renal colic (16).…”