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Toothpick impaction in a sigmoid diverticulum
  1. Shanesh Kumar1,
  2. Ramin Mehdipour2,
  3. Asiri Arachchi3,
  4. Antony Cass1
  1. 1Surgery, Eastern Health, Box Hill, Victoria, Australia
  2. 2Surgery, Austin Health, Heidelberg, Victoria, Australia
  3. 3Surgery, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Ramin Mehdipour, ramin.mehdipour{at}


A 70-year-old woman presented to our emergency department with recurrent episodes of left lower quadrant pain. She subsequently underwent high anterior resection with working diagnosis of acute diverticulitis, but intraoperatively was found to have perforated sigmoid diverticulum due to toothpick impaction. A high index of suspicion is required for diagnosis of toothpick ingestion. Appropriate preoperative investigations such as endoscopy and CT, despite their fairly low sensitivity, should be performed to increase the ability to accurately diagnose this condition and therefore optimise subsequent management.

  • gastrointestinal surgery
  • general surgery

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  • Contributors SK undertook the planning and performed literature review and consented the patient.

    RM undertook literature review, editing and revision of the report.

    AA undertook planning, provided the images and collaborated with the pathology service.

    AC performed the operation, and undertook planning and editing of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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