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An unusual presentation of toothpick penetration of colon.

Wani I, Wani SA, Mir S, Parra K - J Emerg Trauma Shock (2010)

Bottom Line: Role of omentum "policeman of abdomen" for salvage is highlighted.Careful observation and long-term lookup for any neglected ingested foreign body are stressed.The delayed presentation can be sometimes proving as a surgical emergency.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, SMHS Hospital, Srinagar, Kashmir, India.

ABSTRACT
This case report presents the delayed unusual presentation of plastic toothpick penetrating transverse colon 3 months after ingestion with localized peritonitis. Role of omentum "policeman of abdomen" for salvage is highlighted. Careful observation and long-term lookup for any neglected ingested foreign body are stressed. The delayed presentation can be sometimes proving as a surgical emergency.

No MeSH data available.


Related in: MedlinePlus

Inflammed looking omentum freed from site of penetration
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Figure 0002: Inflammed looking omentum freed from site of penetration

Mentions: An 82-year-old man, with dementia, presented to the emergency department with right lower abdominal pain, nausea, vomiting, constipation, and fever of 3 days duration. His vital signs were normal, except a temperature of 100°F. The only positive findings on his clinical examination were rebound tenderness and guarding in a right lower abdomen. Other than a leukocytosis of 10,500/mm3, with 88% neutrophils, his blood urea and serum creatinine were 40 mg/dL and 1.2 mg/dL, respectively. His urine analysis, metabolic profile, and serum amylase levels were normal. Computerized tomography of abdomen revealed the presence of perforated appendicitis. The patient underwent emergency laparotomy where it was noticed that the omentum was adherent to the antimesenteric border of a transverse colon in a right lower quadrant, and the appendix looked normal. Further exploration of the abnormally noticeable omentum revealed a yellow toothpick of 0.5 cm thick emanating from the organized omental lump, emerging about 5 cm from the hepatic flexure of a transverse colon [Figures 1 and 2]. The toothpick was extracted, and the patient made an uneventful recovery. Toothpicks in the gastrointestinal tract have a tendency to lodge in a location where there is an anatomic sphincter, acute angulations, physical narrowing prior surgery, or congenital gut malformation. Predisposing factors for this malady are persons with low IQ, personality disorders, those wearing artificial dentures, and alcoholics, callousness during toothpick use, palatal insensitivity, and pediatric age group. Dementia sometimes may create unawareness and loss of recollection while swallowing a toothpick which may prove challenging to reach a fast diagnosis. Ingested toothpicks are notorious for manifesting as a gastrointestinal bleeding, gut obstruction, bowel perforation, sepsis hemorrhage, and death.[1] Toothpicks have been reported to have the highest rate of impaction and perforation (9%).[2] Perforations of the gastrointestinal tract by ingested toothpicks are rare, with an annual rate of 0.2 per 100,000 persons.[3] Toothpick-related perforations are reported throughout the gastrointestinal tract, including the stomach, duodenum, small bowel, Meckel’s diverticulum, appendix, cecum, sigmoid colon, and rectum, with complications. Symptoms and signs associated with toothpick perforation mimic several intra-abdominal diseases, including diverticulitis, appendicitis, renal colic, and inflammatory bowel disease. Toothpick lodged in a colon is forced by peristalsis to make a sharp right turn, resulting in penetration of the mucosa, which can lead to migration to other organs close to the perforating site, thereby demonstrating a very different clinical pathology.[1]


An unusual presentation of toothpick penetration of colon.

Wani I, Wani SA, Mir S, Parra K - J Emerg Trauma Shock (2010)

Inflammed looking omentum freed from site of penetration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966576&req=5

Figure 0002: Inflammed looking omentum freed from site of penetration
Mentions: An 82-year-old man, with dementia, presented to the emergency department with right lower abdominal pain, nausea, vomiting, constipation, and fever of 3 days duration. His vital signs were normal, except a temperature of 100°F. The only positive findings on his clinical examination were rebound tenderness and guarding in a right lower abdomen. Other than a leukocytosis of 10,500/mm3, with 88% neutrophils, his blood urea and serum creatinine were 40 mg/dL and 1.2 mg/dL, respectively. His urine analysis, metabolic profile, and serum amylase levels were normal. Computerized tomography of abdomen revealed the presence of perforated appendicitis. The patient underwent emergency laparotomy where it was noticed that the omentum was adherent to the antimesenteric border of a transverse colon in a right lower quadrant, and the appendix looked normal. Further exploration of the abnormally noticeable omentum revealed a yellow toothpick of 0.5 cm thick emanating from the organized omental lump, emerging about 5 cm from the hepatic flexure of a transverse colon [Figures 1 and 2]. The toothpick was extracted, and the patient made an uneventful recovery. Toothpicks in the gastrointestinal tract have a tendency to lodge in a location where there is an anatomic sphincter, acute angulations, physical narrowing prior surgery, or congenital gut malformation. Predisposing factors for this malady are persons with low IQ, personality disorders, those wearing artificial dentures, and alcoholics, callousness during toothpick use, palatal insensitivity, and pediatric age group. Dementia sometimes may create unawareness and loss of recollection while swallowing a toothpick which may prove challenging to reach a fast diagnosis. Ingested toothpicks are notorious for manifesting as a gastrointestinal bleeding, gut obstruction, bowel perforation, sepsis hemorrhage, and death.[1] Toothpicks have been reported to have the highest rate of impaction and perforation (9%).[2] Perforations of the gastrointestinal tract by ingested toothpicks are rare, with an annual rate of 0.2 per 100,000 persons.[3] Toothpick-related perforations are reported throughout the gastrointestinal tract, including the stomach, duodenum, small bowel, Meckel’s diverticulum, appendix, cecum, sigmoid colon, and rectum, with complications. Symptoms and signs associated with toothpick perforation mimic several intra-abdominal diseases, including diverticulitis, appendicitis, renal colic, and inflammatory bowel disease. Toothpick lodged in a colon is forced by peristalsis to make a sharp right turn, resulting in penetration of the mucosa, which can lead to migration to other organs close to the perforating site, thereby demonstrating a very different clinical pathology.[1]

Bottom Line: Role of omentum "policeman of abdomen" for salvage is highlighted.Careful observation and long-term lookup for any neglected ingested foreign body are stressed.The delayed presentation can be sometimes proving as a surgical emergency.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, SMHS Hospital, Srinagar, Kashmir, India.

ABSTRACT
This case report presents the delayed unusual presentation of plastic toothpick penetrating transverse colon 3 months after ingestion with localized peritonitis. Role of omentum "policeman of abdomen" for salvage is highlighted. Careful observation and long-term lookup for any neglected ingested foreign body are stressed. The delayed presentation can be sometimes proving as a surgical emergency.

No MeSH data available.


Related in: MedlinePlus