爪楊枝誤飲による大腸穿孔の１例

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  • A CASE OF PERFORATION OF THE COLON BY AN ACCIDENTALLY SWALLOWED TOOTHPICK

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Perforation of the gastrointestinal tract by an accidentally swallowed toothpick rarely happens, and its preoperative diagnosis is difficult because these patients rarely relate a history of swallowing a toothpick and most toothpicks are not radiopaque. We report an operated case of this disease successfully diagnosed preoperatively.<br>A 59-year-old woman was admitted to the hospital because of right lower quadrant abdominal pain and she stated that three days earlier she had accidentally swallowed a toothpick. There was tenderness in the right lower quadrant without signs of peritoneal irritation, and laboratory data were normal, except slight inflammatory reaction. Since X-ray films of the abdomen, gastrofiberscopy, ultrasonography (US) and CT revealed no signs of foreign bodies or perforation of the gastrointestinal tract, conservative therapy expecting spontaneous discharge was attempted. However, on 6th day after admission, US demonstrated a hyperechoic linear image, possibly representing a foreign body, apparently a toothpick and CT confirmed the presence of the toothpick. Emergency operation was done, and an abdominal exploration revealed a toothpick protruding through the ascending colon.<br>So far another 14 cases of perforation of the gastrointestinal tract by a swallowed toothpick have been seen in the Japanese literature. These rare 15 cases including ours are discussed in terms of clinical characteristics here.

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