INTERNATIONAL JOURNAL OF CLINICAL INVESTIGATION AND CASE REPORTS - Volume 1, Issue 3, Nov-Dec

Pages: 56-62

Chronic Evolution of a Covered Perforation of Middle Third Transverse Colon by a Toothpick: A Case Report

Bogdan Severus Gaspar*, Sanda Maria Cretoiu, Mircea Beuran, Irina Mihaela Bejenaru, Iulia Cristina Parvulescu, Stefania Lavinia Manolescu, Ramona Iliescu, Alfred Najm (ROMANIA)

Category: Surgery

Download PDF

Abstract:

Background: Foreign bodies (FBs) ingestion is generally rare but they can cause often bowel perforation if they have a sharp form and the patient did not manage to eliminate it naturally in the stools. Sometimes they can pierce the digestive tube wall leading to acute complications. Among the numerous cases of ingestion of FBs presented in the literature, the current case of transverse colon perforation, with chronic evolution, epiploic and pelvic abscess, submesocolic perivisceritis represents a particular one.

Case Presentation: We present a case of a 59-year-old female patient, reported episodes of transitory melena in the past 6 months and chronic pain in the right iliac fossa, chronic anemia after ingesting a toothpick. The patient complained of chronic pain in the right iliac fossa, melena, intestinal transit disorders et impaired digestive tolerance. Computerized Tomography (CT) scan suggested peritonitis with pelvic adhesions and possible covered perforation in the right iliac fossa. Surgery started as an exploratory laparotomy to define the final diagnosis since a tumoral pathology couldn’t be eliminated. Colic perforation by a toothpick was found, followed by colporrhaphy and a biosynthetic patch on the great omentum.

Conclusion: This paper presents the case of a patient with a sharp foreign body (toothpick) positioned in the transverse colon. The toothpick was ingested a few months ago and had a subtle chronic evolution causing colon perforation, covered peritonitis, intra-abdominal abscess, and chronic anemia because of recurrent episodes of melena. The treatment of choice was surgery with good postoperative evolution.

Keywords: Foreign Body, Toothpick, Colon Covered Perforation, Surgery, Ultrasound, Computerized Tomography

References:

1. Zhang X, Jiang Y, Fu T, Zhang X, Li N, Tu C. Esophageal foreign bodies in adults with different durations of time from ingestion to effective treatment. J Int Med Res. 2017;45(4):1386-1393.
2. Zong Y, Zhao H, Sun C, Ji M, Wu Y, Zhang S, et al. Differences between intentional and accidental ingestion of foreign body in China. BMC Gastroenterol. 2020;20(1):90.
3. Dipasquale V, Romano C, Iannelli M, et al. Managing Pediatric Foreign Body Ingestions: A 10-Year Experience. Pediatr Emerg Care. 2022;38(1):e268-e271.
4. Jaan A, Mulita F. Gastrointestinal Foreign Body. StatPearls. Treasure Island (FL)2022.
5. Geng C, Li X, Luo R, Cai L, Lei X, Wang C. Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases. Scand J Gastroenterol. 2017;52(11):1286-1291.
6. Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(5):489-496.
7. Muller KE, Arato A, Lakatos PL, Papp M, Veres G. Foreign body impaction in the sigmoid colon: a twenty euro bet. World J Gastroenterol. 2013;19(24):3892-3894.
8. Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085-1091.
9. Taylor JE, Campbell M, Daley B. The Management of Small Bowel Obstruction Caused by Ingested Gastrostomy Tube. Am Surg. 2019;85(8):e372-e373.
10. Yao CC, Wu IT, Lu LS, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract of Adults. Biomed Res Int. 2015;2015:658602.
11. Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med. 2015;66(6):570-582.
12. Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children: An Update. Radiol Clin North Am. 2017;55(4):845-867.
13. Steinbach C, Stockmann M, Jara M, Bednarsch J, Lock JF. Accidentally ingested toothpicks causing severe gastrointestinal injury: a practical guideline for diagnosis and therapy based on 136 case reports. World J Surg. 2014;38(2):371-377.

DOI: 10.55828/ijcicr-13-11

DOI URL: http://dx.doi.org/10.55828/ijcicr-13-11