Presentation
Fever accompanied by right iliac fossa pain. Blood tests reveal elevated white blood cell count and neutrophil percentage.
Patient Data
the appendix in the right iliac fossa is dilated, measuring approximately 14 mm in diameter, with a thickened wall, surrounding fat stranding, peritoneal thickening, and thickening of the adjacent cecal base
within the appendiceal lumen is a thin, elongated foreign body (~3cm) with increased density on non-contrast imaging
multiple enlarged mesenteric lymph nodes in the right iliac fossa suggest reactive lymphadenopathy
a simple renal cyst is noted in the right kidney
diffuse hypodensity of the hepatic parenchyma on non-contrast imaging, possibly indicating fatty liver
Post-3D reconstruction images reveal a foreign body in the right iliac fossa region.
Surgical findings:
the appendix is located in the right iliac fossa, measuring 1 x 8 cm and shows necrotizing inflammation with perforation near its base
a significant amount of purulent fluid is present in the right iliac fossa and Douglas pouch. The intestinal loops and greater omentum in the right iliac region are congested
during laparoscopic appendectomy, necrotic perforation near the appendix base was noted, containing a fecalith and a bamboo toothpick protruding through the perforation. The appendix base appeared friable
Case Discussion
The imaging findings, blood test results, and surgical observations are consistent with acute appendicitis caused by a foreign body (bamboo toothpick). The clinical symptoms improved postoperatively, and the patient was discharged a few days later.
A bamboo toothpick is a common item in Vietnam. It is typically a long stick with pointed ends, used after meals to clean between the teeth. The habit of using and keeping a bamboo toothpick in the mouth, especially while falling asleep, increases the risk of inadvertently swallowing it, which can lead to complications, such as in this case.
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