Value of laparoscopy in the treatment of cecal perforation by a foreign body: differential diagnosis of appendicitis

Abstract

A 24-year-old male, with no medical history of interest, who was admitted into emergency care for acute abdomen. The patient complained of pain in the right lower quadrant (RLQ) persisting for the last 48 hours, unrelated to any trigger. Initially, the pain was of moderate intensity, followed by associated fever, anorexia, and malaise. Initial analysis revealed a C-reactive protein of 2.4 mg/dL and a leukocyte count in the upper normal limit. Physical examination revealed Blumberg sign in the RLQ. Abdominal ultrasound resulted inconclusive, so the test was complemented with CT scan which revealed a foreign body piercing the cecum, with no pneumoperitoneum or peritonitis (Fig. 1). An emergency exploratory laparoscopy was performed which identified the foreign body to be a toothpick (wooden) traversing the cecum with minimal purulent material ( Fig. 2A). The foreign body was removed and the incision was sealed with three silk sutures (Fig. 2B). Patient was discharged uneventfully.