Sonographic detection of clinically unsuspected swallowed toothpicks and their gastrointestinal complications

Rioux, Michel; Langis, Paul

doi:10.1002/jcu.1870220805

Cited by 45 publications

(26 citation statements)

References 16 publications

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“…In fact, the toothpick entered and lodged in the hepatogastric ligament. As in other cases reported in the literature, the patient had no recollection of its ingestion [2]. …”

Section: Discussionmentioning

confidence: 60%

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Asymptomatic Gastric Perforation by a Toothpick

Porcu

Dessanti²,

Feo³

et al. 1999

Dig Surg

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Background: Many cases of gastric perforation with peritonitis, pylephlebitis, hepatic abscesses, or lethal bleeding, caused by ingested long and sharp objects, are reported in the literature. Methods: During a right hepatectomy for a giant hemangioma, a wooden toothpick was found between the two layers of the hepatogastric ligament. It was not possible to find the passage of the foreign body through the gastric wall. The patient did not report any correlated symptoms. Results: There was no sign of inflammation around the toothpick, which was enveloped in thin scar tissue. The removal of the foreign body was performed without complications. Conclusions: The peculiarity of our case is the total absence of symptoms during and after the perforation. Despite the benign evolution of our case, toothpicks must be considered as potentially dangerous, like other pointed objects, and, therefore, removed immediately.

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“…In fact, the toothpick entered and lodged in the hepatogastric ligament. As in other cases reported in the literature, the patient had no recollection of its ingestion [2]. …”

Section: Discussionmentioning

confidence: 60%

“…Many cases of gastrointestinal perforation with peritonitis, pylephlebitis, constrictive pericarditis, or severe bleeding caused by ingested toothpicks, are reported in the literature [2, 3, 4, 5]. …”

Section: Discussionmentioning

confidence: 99%

Asymptomatic Gastric Perforation by a Toothpick

Porcu

Dessanti²,

Feo³

et al. 1999

Dig Surg

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“…Another important observation is that sonography may underestimate the length of these toothpicks, probably because only the extraluminal portion is easily visualized, while the intraluminal portion is often obscured by intestinal gas. 2 In our patient, a definite diagnosis of a sharp foreign object penetrating from the duodenum to the liver was made using sonography, and the exact length of the toothpick was measured, although part of it was within the duodenal lumen.…”

Section: Discussionmentioning

confidence: 99%

“…1 Usually, these complications occur with long, hard, sharp, indigestible foreign bodies such as toothpicks, which have a higher chance of perforating the gastrointestinal wall. 2 Although gastrointestinal perforations caused by foreign bodies are relatively rare, once a perforation occurs, it may cause a variety of complications, and there may even be some difficulty in diagnosing such perforations. Unfortunately, many patients with a toothpick in the gastrointestinal tract have no memory of ingesting it.…”

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confidence: 99%

Sonographic diagnosis of a toothpick traversing the duodenum and penetrating into the liver

Chiang

Liu

Lee

et al. 2006

J of Clinical Ultrasound

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Ingested foreign bodies rarely cause gastrointestinal perforation, because the majority are passed out uneventfully in the feces. However, long, sharp, slender, hard, indigestible objects such as toothpicks are dangerous and may lead to potentially life-threatening complications. We report a case of duodenal perforation caused by a toothpick and complicated by liver abscess and methicillin-resistant Staphylococcus aureus sepsis. Although laparotomy was not performed because of the patient's refusal to undergo surgery, the liver abscess and sepsis were controlled successfully with antibiotics. We also conducted a literature search for reports on injuries caused by ingested toothpicks.

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“…There are several older reports on the value of US for the depiction of foreign bodies (7)(8)(9)(10). In recent years, however, the wide availability of MDCT has resulted in its greater use in emergency departments and has limited the use of US in the evaluation of acute abdomen cases.…”

Section: Discussionmentioning

confidence: 99%

Acute abdomen caused by small bowel perforation by a clinically unsuspected fishbone: a case report

Drakonaki

Chatzioannou²,

Spiridakis³

et al. 2010

Diagn Interv Radiol

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A ccidental foreign body ingestion is commonly encountered in clinical practice. However, bowel perforation by a foreign body is less common, as the majority of foreign bodies uneventfully pass to the feces and only 1% of them (the sharper and more elongated objects) will perforate the gastrointestinal tract, usually at the level of the ileum (1). Computed tomography (CT), especially multidetector CT (MDCT), is considered the method of choice for preoperative diagnoses of ingested foreign bodies and their complications due to its high-quality multiplanar capabilities and high resolution (2-6). The increased availability and effectiveness of MDCT has limited the use of ultrasonography (US) in investigations of acute abdominal pain (2). As a result, only a few older reports (using outdated equipment) have investigated the use of US in the diagnosis of ingested foreign bodies (7-10).Herein, we report a case of small bowel perforation and omental granuloma caused by a clinically unsuspected fish bone in which US led to a precise preoperative diagnosis and successful surgical treatment. In the era of MDCT, we highlight the usefulness of current-generation US as a radiation-free investigative tool in cases of acute abdominal pain caused by ingested foreign bodies. Case reportA 78-year-old overweight woman presented to the emergency department of our hospital with a three-day history of increasing periumbilical abdominal pain and persistent vomiting. Upon clinical examination, there was tenderness with guarding of the right upper abdomen and an elevated temperature (38.5 °C). Laboratory tests revealed increased inflammatory markers including a white blood cell count of 18.7x10 3 /μL (85% neutrophils) and a C-reactive protein level of 180 mg/L. The remaining blood test parameters were unremarkable.An abdominal X-ray in the supine position showed the presence of a distended small bowel loop at the middle abdomen but no signs of free abdominal gas or other remarkable findings (Fig. 1). The patient was referred for an abdominal US, which revealed the presence of a markedly hypoechoic mass with minimal vascularity. The mass measured approximately 4.5 cm in diameter at the right periumbilical area and contained a thin, straight, hyperechoic structure measuring 3.3 cm in length that was associated with slight posterior shadowing depending on the probe position. The fat surrounding the lesion was intensely hyperechoic, and there was an aperistaltic hypoechoic sentinel small bowel loop adjacent to the mass and connected to it by way of a linear hypoechoic sinus tract (Fig. 2). These findings raised suspicion that a foreign body was present, as this could cause both a small bowel perforation and a reactive mass.Because the patient was rapidly deteriorating, a CT scan was not performed, and the clinical decision was made to perform an urgent surgical ABSTRACT We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs ...

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Sonographic detection of clinically unsuspected swallowed toothpicks and their gastrointestinal complications

Cited by 45 publications

References 16 publications

Asymptomatic Gastric Perforation by a Toothpick

Asymptomatic Gastric Perforation by a Toothpick

Sonographic diagnosis of a toothpick traversing the duodenum and penetrating into the liver

Acute abdomen caused by small bowel perforation by a clinically unsuspected fishbone: a case report

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