Case Report: Duodenal perforation complicated by psoas muscle collection and spondylodiscitis successfully managed without surgery - An unusual case of a toothpick ingestion

Abstract

Perforation of the intestine caused by an ingested foreign object remains a complex challenge in terms of clinical presentation, diagnosis, and treatment. A 55-year-old man presented with complaints of right-sided abdominal pain and functional impairment of the lower limbs. Physical examination revealed an afebrile status and tenderness in the right upper quadrant of the abdomen. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a duodenal perforation caused by a densely linear foreign body. Additionally, a collection in the psoas muscle and contiguous spondylodiscitis were identified. To address this condition, an endoscopic procedure was performed to extract the toothpick successfully, and a CT-guided fine-needle aspiration was conducted to collect the fluid. Spondylodiscitis was managed with antibiotic therapy and immobilization. Remarkably, significant clinical and radiological improvement was observed within a span of three weeks. This case emphasizes the importance of multidisciplinary care involving interventional treatments as a viable and safe alternative to surgical intervention.