title: Duodenal perforation and right hydronephrosis due to toothpick ingestion.
abstract: We report a case of a 36-year-old man who was admitted to the Emergency Department with right flank pain. The clinical presentation was suggestive of renal colic. However, a computed tomography scan showed the presence of a foreign body in the inferior duodenal flexure. Upper gastrointestinal endoscopy demonstrated a 6.5-cm wooden toothpick deeply embedded in the duodenal wall; this was removed via endoscopy. The peri-duodenal inflammatory reaction had encased the right ureter, resulting in hydronephrosis. The patient did well and was discharged on post-operative day 7. He did not recall toothpick ingestion. When evaluating patients with acute abdominal pain, foreign body ingestion should be considered. In patients with a history of toothpick ingestion, immediate diagnosis with endoscopic management should be performed.
authors.affiliation: Department of Surgery, La Sapienza University of Rome, II School of Medicine, Rome, Italy.
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: Nigri
authors.forename: Emilio
authors.initials: E
authors.lastname: Di Giulio
authors.forename: Raffaella
authors.initials: R
authors.lastname: Di Nardo
authors.forename: Francesca
authors.initials: F
authors.lastname: Pezzoli
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Angelo
authors.forename: Paolo
authors.initials: P
authors.lastname: Aurello
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D004435:Eating; D005547:Foreign Bodies; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D011859:Radiography