Chronic Evolution of a Covered Perforation of Middle Third Transverse Colon by a Toothpick: A Case Report

Abstract

Background: Foreign bodies (FBs) ingestion is generally rare but they can cause often bowel perforation if they have a sharp form and the patient did not manage to eliminate it naturally in the stools. Sometimes they can pierce the digestive tube wall leading to acute complications. Among the numerous cases of ingestion of FBs presented in the literature, the current case of transverse colon perforation, with chronic evolution, epiploic and pelvic abscess, submesocolic perivisceritis represents a particular one. Case Presentation: We present a case of a 59-year-old female patient, reported episodes of transitory melena in the past 6 months and chronic pain in the right iliac fossa, chronic anemia after ingesting a toothpick. The patient complained of chronic pain in the right iliac fossa, melena, intestinal transit disorders et impaired digestive tolerance. Computerized Tomography (CT) scan suggested peritonitis with pelvic adhesions and possible covered perforation in the right iliac fossa. Surgery started as an exploratory laparotomy to define the final diagnosis since a tumoral pathology couldn’t be eliminated. Colic perforation by a toothpick was found, followed by colporrhaphy and a biosynthetic patch on the great omentum. Conclusion: This paper presents the case of a patient with a sharp foreign body (toothpick) positioned in the transverse colon. The toothpick was ingested a few months ago and had a subtle chronic evolution causing colon perforation, covered peritonitis, intra-abdominal abscess, and chronic anemia because of recurrent episodes of melena. The treatment of choice was surgery with good postoperative evolution.