Presentation
1 week of abdominal pain, worse in the last 24 hours, with tenderness, distension and constipation.
Patient Data
Non contrast CT abdomen pelvis
A 4.5cm linear hyperdense foreign body projects between the distal sigmoid colon and mid small bowel. Extensive pneumoperitoneum, originating from around the rectosigmoid junction.
Extensive diverticulosis without focal changes of diverticulitis.
Case Discussion
On initial review, the case could easily be misdiagnosed as a perforated diverticulum, but closer inspection reveals a hyperdense perforating foreign body which cannot be managed non-operatively. The patient was taken for emergency laparotomy, where a toothpick was found to have perforated through the jejunum and distal colon. The patient underwent a Hartmann procedure.
The patient initially recovered post-op and was stepped down from ICU, but unfortunately they subsequently deteriorated and died 6 days later.
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