Computed Tomographic Detection of Toothpick Perforation of the Jejunum: Case Report and Review of the Literature

Foreign body ingestion is commonly encountered in the emergency department. Although in most cases, the ingested object will pass uneventfully in the feces [1], ingestion of sharp foreign bodies such as dental plates, sewing needles, toothpicks, fish bones and chicken bones carries increased risk of gastrointestinal perforation [2, 3, 4]. The use of toothpicks as both tooth-clearing implements and eating utensils increase the likelihood of toothpick unintentional ingestion [5]. Toothpicks account for 9% of reported foreign bodies ingested [6]. These pointed wooden bodies when accidentally swallowed are associated with higher risk of complications, such as gastric, small bowel or colonic perforation, obstruction, colonic impaction, gastrointestinal bleeding, subphrenic abscess, fistula formation, sepsis and/or death due to the damaged caused by the sharp pointed ends [7, 8, 9]. Unfortunately, many patients who ingested such objects fail to remember the mis-swallowing event when symptoms of perforation develop, making diagnosis problematic. We present a case of jejunal perforation secondary to an ingested wooden toothpick correctly diagnosed with Computed Tomography (CT).