A Case of Penetration of the Rectum by a Toothpick that Presented with Thigh Pain

Abstract

A 67-year-old man visited a medical clinic complaining of right thigh pain in September 2018. CT and MRI examinations were performed with suspicion of lumbar spinal canal stenosis. Imaging showed the rectum penetrated by a cord-shaped foreign body between the upper rectum and sacrum. It was speculated that the symptoms were caused by the foreign body, because the tip of the foreign body was near the 2^nd sacral nerve. The patient was referred to our hospital for elective surgery, but his thigh pain got worse, so he was brought to the hospital by an ambulance in December. When examined in the emergency department, his general condition was good, afebrile, and no signs of peritoneal irritation. Colonoscopy disclosed a stick-shaped foreign body stuck into the wall of the rectum 15 cm proximal to the anus. Emergency surgery was performed with a diagnosis of penetration of the rectum by a foreign body. At laparoscopic surgery, the foreign body was removed and recognized as a toothpick. Postoperatively, his symptoms disappeared. He was unaware of the ingestion of the toothpick, but he had a habit of sleeping with the toothpick in his mouth. Rectal penetration by a toothpick with lower extremity symptoms is rare.