Duodenal perforation due to toothpick perforation, an uncommon cause of chronic abdominal pain

Abstract

A 55-year-old woman presented with a 3month history of chronic left upper quadrant abdominal pain. She had no previous medical history. Her symptoms were not associated with nausea or emesis. Physical examination showed an afebrile patient with left upper quadrant abdominal tenderness. Laboratory tests demonstrated an elevated white cell count of 15000/L (normal range 4000 -10000/L). C reactive protein was 50 mg/dL (normal < 5 mg/mL). Liver function tests were normal. Images from ultrasonography exploration were considered normal. An abdominal computed tomography (CT) scan demonstrated an infiltration of periduodenal tissue above the angle of Treitz and a hyperdense needle-shaped structure penetrating the duodenal wall