Cecum and appendix perforation due to inadvertent ingestion
The patient is a 27-year-old male with no significant past medical history. He presented to the emergency room with a 24-hour history of lower abdominal pain, nausea, and vomiting. On clinical examination, a febrile, tachycardic and dehydrated patient was encountered. He reported pain on his right lower quadrant with a positive Mcburney sign and localized abdominal tenderness. Laboratory blood analyses revealed leukocytosis with neutrophilia. With these findings, acute abdomen due to appendicitis was suspected, and surgery was decided.

Intravenous antibiotics were commenced preoperatively and a Mcburney incision was made, multiple adhesions were found near the cecum, and the cecum wall appeared hyperemic with intense inflammation near the base of the appendix. After blunt dissection, two 3 cm toothpicks were discovered, one that perforated the appendix wall near its base and another one that jeopardized the cecum wall

After surgery, the unusual discovery was reported to the patient. However, he didn’t recall swallowing the toothpicks. His postoperative course was uneventful, and he was discharged after a full diet was tolerated. In follow-up controls, the patient shows signs of recovery, and still has no memory of having ever swallowed the toothpicks.

Source: Journal of Surgical Case Reports, Volume 2019, Issue 4, April 2019, rjz106

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