Foreign Body Related Micro-Perforation Managed by Colonoscopy after A Failed Laparoscopic Exploration-A Case Report

Hollow organ perforation is usually resulted from foreign body ingestion or trauma in young patients without systemic disease. Surgery is the traditionally definite therapy for intestinal perforation, but endoscopic removal of foreign bodies is an alternative method in foreign body-related intestinal perforation. An exploratory laparotomy with midline incision is usually performed and provides access to the entire abdomen, but sporadic articles mentioned about perforating foreign body diagnosed and managed by laparoscopy due to its narrow vision and impalpability. We reported a case of a 28-year-old male without systemic disease suffered from intermittent peri-umbilical pain for 7 days. The patient swallowed a toothpick 15 days prior to examination. Although abdominal computed tomography revealed pneumoperitoneum in the left upper quadrant area, laparoscopy showed no evidence of hollow organ perforation. Colonoscopy successfully found and removed a toothpick at the rectosigmoid junction 3 days after laparoscopy. Laparotomy, but not laparoscopy, is the traditionally definitive diagnostic and therapeutic method, and endoscopic therapy could be an alternative and salvage method in foreign body-related intestinal perforation.