# Laparoscopic Management of Jejunal Perforation Caused by Toothpick Ingestion: A Case Report

## TL;DR

A 62-year-old man with a toothpick-induced jejunal perforation was successfully treated with laparoscopic surgery, highlighting the effectiveness of this minimally invasive approach.

## Contribution

This case report presents a successful laparoscopic management of jejunal perforation caused by a toothpick, emphasizing the role of CT and minimally invasive techniques.

## Key findings

- Computed tomography accurately identified a jejunal perforation caused by a radiolucent toothpick.
- Laparoscopic surgery enabled safe removal of the foreign body and repair of the bowel with no complications.
- The patient had an uneventful recovery and remained asymptomatic at follow-up.

## Abstract

Foreign body ingestion is a frequent clinical problem, although most ingested objects pass spontaneously through the gastrointestinal tract. Sharp and elongated foreign bodies, such as toothpicks, are associated with a higher risk of perforation and may present diagnostic challenges due to their radiolucent nature.

We report the case of a 62-year-old man who presented with a four-day history of abdominal pain, fever, nausea, and signs of peritoneal irritation. Laboratory tests revealed leukocytosis and elevated inflammatory markers. Contrast-enhanced abdominal computed tomography demonstrated a linear foreign body approximately 4 cm in length, oriented perpendicular to the jejunal axis, with focal bowel wall thickening and adjacent mesenteric inflammation, consistent with small-bowel perforation.

Urgent diagnostic laparoscopy was performed. Intraoperatively, minimal inflammatory fluid and localized fibrinopurulent plaques were observed. Two small jejunal perforations were identified, one of which contained a protruding wooden toothpick. The foreign body was removed laparoscopically, and primary enterorrhaphy was performed. The postoperative course was uneventful, with early return of bowel function and no infectious or surgical complications. The patient was discharged on postoperative day 4 and remained asymptomatic at follow-up.

This case highlights the importance of maintaining a high index of suspicion for gastrointestinal perforation following the ingestion of sharp foreign bodies. Computed tomography plays a central role in diagnosis, and in selected stable patients, laparoscopy provides a safe and effective approach for definitive management, allowing diagnosis, foreign body extraction, and bowel repair in a single minimally invasive procedure.