BMJ Case Reports 2018; doi:10.1136/bcr-2018-225258
  • Learning from errors

Small bowel perforation by toothpick

  1. Tun Hing Lui2
  1. 1Department of Surgery, Prince of Wales Hospital, Hong Kong
  2. 2Orthopaedics and Traumatology, North District Hospital, Hong Kong, Hong Kong
  1. Correspondence to Dr Carol Man Sze Lai, carollai{at}
  • Accepted 16 June 2018
  • Published 11 July 2018


Toothpick ingestion is a rare but potentially fatal condition which may cause bowel perforation and rare complications if it migrates out of the gastrointestinal tract. This case report describes a delayed presentation of toothpick-induced small bowel injury leading to abdominal wall abscess and spondylodiscitis. A 51-year-old man was admitted twice with fever and loin pain, but repeated non-contrast CT was reported to be unremarkable. However, 5 months later, he presented with a left lower quadrant abdominal wall abscess and back pain. An updated CT showed a linear hyperdensity which was already present in previous scans, causing small bowel perforation, abdominal wall abscess and spondylodiscitis. Emergency laparotomy identified a toothpick causing small bowel perforation. The abdominal wall abscess was incised and drained, and small bowel was repaired.


  • Contributors CMSL prepared the manuscript. THL collected the clinical data and supervised the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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