Toothpick: An Unusual Cause of Small Bowel Perforation in an Adult

Abstract

Foreign body ingestion is a common complaint in the pediatric population; however, in adults, this entity remains quite rare. Most cases are managed conservatively with serial examinations and imaging. Rarely, foreign body ingestion may cause small bowel perforation and peritonitis in adults. Perforation often warrants operative management, and assessment of bowel viability is crucial. Here, we present a case of foreign body ingestion requiring exploration, without the need for bowel resection or repair. Although the need for operative intervention in adults after foreign body ingestion remains rare, it is crucial to recognize those patients who are both at risk for foreign body ingestion and have underlying small bowel narrowing that puts them at risk for perforation. A high index of suspicion in these instances is mandatory as early recognition and appropriate treatment will improve outcomes.

Keywords: bowel perforation; foreign body ingestion; laparotomy decision; small bowel obstruction; toothpick.

Figure 1. Axial non-contrast CT imaging of the abdomen and pelvis demonstrating the linear hyperlucent object appearing to lie within a loop of the small bowel.

Figure 2. Intraoperative and gross pathology photos

(a) Small bowel mesentery with a foreign object as discovered intraoperatively, indicated by black arrow. (b) Gross examination of the removed specimen, measuring approximately 4.6 cm.