A total of 136 cases (74 % male, age 52 [5-92] years) have been reported in the literature. CT‐scan showing the abscess formation in segment V of the liver with an air bubble (thick white arrows) and fat stranding between the colonic hepatic flexure and the liver (thin white arrows). -. Introduction Foreign body ingestion is responsible for around 1500 cases of death in the United States every year [1]. 2002 Jul;23 (1):35-8 We report a case of a 73-year-old female patient presenting mid-term epigastric pain. Patients will report a history of recurrent abdominal pain, fever of unknown origin, like our patient, nausea, obstipation, diarrhea etc. 2008 Mar;32(1):307-9 Conclusions: 3). The overall mortality was 9.6 %. to ingested synthetic foreign bodies or organic ones (animal bones, wooden toothpicks etc.) Epub 2020 Oct 8. Hepatic wedge resection around the foreign object that revealed to be a toothpick (white arrows) protruding through liver segment V. Hepatic specimen removed, with the toothpick lodged inside. 2003 Apr;29(4):662-3 Successful Endoscopic Removal of Toothpick Perforating Gastric Antrum With Over-the-Scope Padlock Clip Closure. Toothpick ingestion and migration into the liver through the colonic hepatic flexure: case presentation, management, and literature review December 2017 Clinical Case Reports 6(1) We have reported a case of small bowel obstruction due to the accidental ingestion of a toothpick. YP: gathered the clinical data, did the literature review, and assisted in the surgical intervention. Toothpick ingestion is a medical emergency. Numerous case reports describing the clinical course in this setting are available but there is no concise guideline. NLM However, it is important to note that in 35% of time the need for laparotomy as an exploratory procedure cannot be ignored. 13-17. Endoscopic extraction of food bolus impaction and foreign body ingestion from the upper digestive tract is successful in 95% of cases.2 17 When endoscopic extraction fails, rigid oesophagoscopy for the upper oesophageal foreign body can be considered. (March 9 issue)1 reported a late septic and hemorrhagic catastrophe after the ingestion of a toothpick. | TUESDAY, Sept. 10 (HealthDay News) -- Accidentally swallowing a toothpick or other foreign object can cause serious health problems, such as blood poisoning or liver abscess. 9. Serologies for Echinococcus granulosus and multilocularis were negative. 2014 Dec;47(6):e133-7. An indurated area was noticed at the site of adhesion with a fine wooden tip protruding. From the available information, more than 50 % (n = 48) of patients were not aware of having swallowed a toothpick. The patient's age, mental capabilities, clinical characteristics, and socioeconomic status should also raise questions. Cureus. Please check your email for instructions on resetting your password. toothpick migration into bladder presents as abdominal pain and hematuria. She was febrile 38.8°C, but had no pertinent signs on her physical examination. 2020 Jul 9;7(7):e00420. The surgeon must know his limitations and should assess the situation before intervening. He did not recall toothpick ingestion. 2010 Jul;26(7):506-7. doi: 10.1097/PEC.0b013e3181e5bf85. It is mainly prevalent in certain high‐risk population such as pediatric patients 2-4, elderly patients with dental prosthesis 5, patients with psychiatric disorders or neurodevelopmental delay, and body pakers 6-8. Adequate therapy depends on localization of the toothpick in the gastrointestinal tract. The authors declare no potential conflict of interest. ities in the management of ingested FBs.2,7,8 Conclusion Toothpick ingestion without awareness is rare but fatal. Although the most common cause of cellulitis is skin disruption (60–80% of cases), the disorder can also have abdominal, perineal, genitourinary, and postoperative origins. Endoscopy showed success mainly when the toothpick location was the stomach (75%), duodenum (70%), and large bowels (45%). In such situations, wide window settings can facilitate the depiction of an air-filled toothpick and reduce the possibility of overlooking the ob-ject. Long‐standing fever with no origin or focus, abdominal pain, obstruction, perforation in young healthy patients etc. About 58% require surgical intervention with an overall mortality of 9.6% 18. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. In all cases of caustic ingestion, the airway should be assessed initially and protected if necessary. He did not recall toothpick ingestion. If endoscopy is not rapidly available and severe injury is strongly suspected, obtain a … Introduction. We report here, for the first time to our knowledge, a retroperitoneal and thigh cellulitis secondary to colonic perforation due to toothpick ingestion. Right extended subcostal incision was made. Sigmoid Colon Perforation Caused by an Unapparent Foreign Body. A case report, Hepatic inflammatory mass secondary to toothpick perforation of the stomach: triphasic CT appearances, Colonoscopic identification of a foreign body causing an hepatic abscess, A pyogenous gastric abscess that developed following ingestion of a piece of a wooden skewer: successful treatment with endoscopic incision, Chronic abdominal liver abscess caused by toothpick perforation of the gastrointestinal wall, Migration of a swallowed toothpick into the liver: the value of multiplanar CT, Pyogenic hepatic abscess secondary to endolumenal perforation of an ingested foreign body. If you do not receive an email within 10 minutes, your email address may not be registered, AEA: wrote the article and assisted in the surgical intervention. Duodenocaval fistula due to toothpick perforation. day after ingestion, and the toothpick appeared as a distinct low density linear structure (11). Diagnosis of toothpick ingestion is very difficult. Toothpick injury mimicking renal colic: case report and systematic review. Perforations of the intestine are common and the associated mortality is high. BACKGROUND: Toothpick ingestion is implicated in bowel injuries that may cause violent complications, mimicking diseases causing acute abdomen. Adequate therapy depends on localization of the toothpick in the gastrointestinal tract. 4). Our Medline search identified 116 publications containing case reports of ingested toothpicks. When evaluating patients with acute abdominal pain, foreign body ingestion should be considered. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The diagnostic work‐up usually consists of EGD, colonoscopy, computed tomography scan, and ultrasound, but failure to detect the toothpick was reported in 35% of the cases. In what follows, we describe the first case of toothpick ingestion, with migration into the liver through the colonic hepatic flexure, how it presented and how it was managed, followed by a brief literature review. Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick Inanc Samil Sarici , A, E, 1 Omer Topuz , D, 2 Yusuf Sevim , F, 2 Talha Sarigoz , C, 2 Tamer Ertan , B, 2 Ozgur Karabıyık , C, 3 and Ali Koc D, 3 Toothpick ingestion is a medical emergency. Algorithm for the diagnosis and management of caustic ingestions. Toothpick ingestion causing rectum perforation. In childhood, almost all swallowed objects that successfully navigate the esophagus pass through the gut without complications. Antoine El Asmar Saint Georges Hospital University Medical Center Faculty of Medicine University of Balamand Beirut Lebanon. Sarici IS(1), Topuz O(2), Sevim Y(2), Sarigoz T(2), Ertan T(2), Karabıyık O(3), Koc A(3). Around 18 cases of intrahepatic toothpick with abscess formation were reported in the literature, with duodenal perforation as the site of penetration in eight cases, the stomach in 6 cases, the sigmoid colon in one case, and unknown entry site in three cases 11, 14, 19-32. Dissection around the foreign object revealed a toothpick embedded in the liver parenchyma (Fig. doi: 10.1097/MD.0000000000009066. Contribution of 3 Cases. HHS Endoscopic Management of Colonic Perforation due to Ingestion of a Wooden Toothpick. Referral to tertiary centers is sometimes mandatory. COVID-19 is an emerging, rapidly evolving situation. 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