Short communication, Note
Massive Gastrointestinal Bleeding and Obstruction of the Ureter Caused by the Migration of a Swallowed Toothpick from the Sigmoid Colon – A Case Report
Marina Maras-Šimunić
Leo Grandić
Darko Brnić
Miroslav Šimunić
Nikica Družijanić
Abstract
In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal
bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted
to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed
tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching
of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to
the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative
laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being
stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the
toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left
ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of
clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks,
and thus, we insist on a physical examination, as the best indicator of injury.
Keywords
swallowed toothpick; arterial-colic fistula; massive gastrointestinal bleeding; obstruction of the ureter
Hrčak ID:
23774
URI
Publication date:
8.5.2008.
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