2019 Volume 39 Issue 1 Pages 133-136
Ingestion of foreign matter can cause gastrointestinal perforation. Herein, we report a case of small-intestinal perforation caused by a toothpick. Diagnosis was difficult because the patient had no recollection of having accidentally ingested any foreign matter and no foreign matter or free air was recognized on imaging examination. The patient, an 81-year-old woman was admitted with abdominal pain and vomiting. Physical examination revealed abdominal tenderness and muscle guarding. The white blood cell count was 13,700/μL, and the serum C-reactive protein was elevated to 13.0mg/dL. Computed tomography revealed ascites, but no foreign matter or free air was observed. Therefore, the cause of the acute generalized peritonitis could not be identified. Emergency diagnostic laparoscopy was performed on the day of admission and a toothpick was found stuck in the terminal ileum. Therefore, the diagnosis was made of a small-intestinal perforation caused by a misdirected toothpick. Partial resection of the small intestine was performed. Thus, diagnostic laparoscopy was beneficial for identification of the cause of the acute generalized peritonitis of unknown origin. When the cause of acute generalized peritonitis cannot be identified clinically, minimally invasive diagnostic laparoscopy should be considered for the purpose of diagnosis and treatment.
