A Case of a Residual Wooden Foreign Body Detected by Computed Tomography After Operation for Jejunal Perforation Induced by a Toothpick

Abstract

An 86-year-old female with a left inguinal hernia consulted our hospital for fever. She was able to swallow solid food. Physical examination revealed diffuse peritonitis, and the left inguinal hernia was reducible without pain. Abdominal computed tomography demonstrated a small amount of free air and the left inguinal hernia, however, the site of perforation could not be detected. No foreign body was demonstrated in the abdominal cavity and gastrointestinal tract. An urgent laparotomy was performed for panperitonitis. As a toothpick was discovered in the pouch of Douglas and perforation of jejunum had occurred where it had herniated to the left groin, resection of the jejunum was performed. Repair of left inguinal hernia was performed 6 days after the operation. Thereafter, her family suggested that she might have injected several wooden foreign bodies, such as a toothpick or stick, 2 days prior to the consultation. Computed tomography performed 8 days after the laparotomy demonstrated a linear area of high density in the cecum, leading to a diagnosis of a residual foreign body. The high density linear area had moved to the transverse colon on computed tomography performed 13 days after the laparotomy. We performed endoscopic removal of a wooden stick 15 days after the laparotomy. The patient was discharged from our hospital 22 days after the laparotomy. For ingestion of foreign bodies, we must ask detailed questions of a patient or their family about the patient's condition, and should perform routine computed tomography postoperatively even if the postoperative course is uneventful.