Perforation of the colon is usually due to diverticulitis, carcinoma, or inflammatory diseases. In rare cases, ingestion of foreign bodies can also cause perforation of the gastrointestinal (GI) tract but the majority of the patients who swallow foreign bodies do not need an operation or endoscopic removal. Foreign bodies are likely to become lodged in the GI tract at areas of narrowing or acute angulation and are more likely to cause GI perforation when objects are long, thin, and sharp. Ingested toothpicks have the potential to cause GI perforation and can migrate from the GI tract into other organs, such as the pericardium, lung, pancreas, liver, bladder, ureter, and vasculature. More than 100 cases have been reported in the literature about ingested toothpicks, among which most of the patients are unaware of having swallowed the toothpick and present with generalized symptoms of abdominal pain followed by fevers and nausea. The ingested toothpick is not detected in noninvasive imaging or endoscopy in one-third of patients. GI perforation occurs in around 80 per cent of patients who ingest toothpicks with most of the toothpicks found in the large bowel (30%), duodenum (23%), stomach (20%), small bowel (18%), and rectum (7%). The majority of these patients required surgical intervention with an overall mortality rate around 10 per cent. A review of the literature documents four cases of toothpick ingestion leading to ureter obstruction and hydronephrosis. These cases involved perforations of the duodenum, cecum, sigmoid, and an unknown GI site. The purpose of this case report is to describe a patient presenting with a sigmoid perforation, right obstructive hydronephrosis, and urosepsis who underwent a right percutaneous nephrostomy tube placement and endoscopic removal of a toothpick in the sigmoid colon.
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