A case of perforation of the sigmoid colon due to a toothpick treated conservatively

Abstract

A 71-year-old woman complaining of lower abdominal pain and abdominal distention was seen at the hospital 2 days after the onset of the pain. When she was first seen, recognizable peritoneal irritation sign was absent. Abdominal ultrasonography showed edema encircling the lumen of the sigmoid colon. Based on physical findings, acute colitis was diagnosed and a drug for controlling intestinal function was prescribed. Thereafter her clinical course had been observed until the 28th day after the first visit, when she was seen at the hospital again because of persisting abdominal symptoms. Lower gastrointestinal endoscopy performed for a suspected lesion of the sigmoid colon disclosed a toothpick (about 65mm in length) stuck in the wall of the sigmoid colon at a portion about 25cm proximal to the anus. The toothpick was removed using an endoscopic forceps per anus. A contrast enhanced CT scan of the abdomen following the removal of the toothpick showed an intra-pelvic abscess, but the inflammatory findings were not so severe. Thus the patient was given drip infusion of antibiotics and administration of the drug for controlling intestinal function on an ambulant basis. Thereafter her clinical course was satisfactory, and the inflammatory findings became negative on the 35^th day after the removal of the foreign body, leading to the termination of treatment.
Lower gastrointestinal perforation due to a toothpick is comparatively rare and this case is reported here, together with some bibliographical comments.