PMC4290385_01
a) X-ray of the abdomen (sagittal plane) showing distension of the small bowel with air fluid levels and no free air. b) Contrast enhanced computed tomography (CT) slide (coronal plane). Extreme distension of the colon. No evidence of free air in the peritoneal cavity.
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Fig1
On plain abdominal X-rays the small bowel was distended and dislocated on the left upper abdominal quadrant with some air-fluid levels (Figure  1a). A contrast-enhanced abdominal computed tomography (CT) scan confirmed bowel occlusion with extreme ileum distension and about 50 ml of free fluid in the Douglas pouch; no evidence of pneumoperitoneum (Figure  1b).
Operative specimen showing the toothpick (arrows) and the site of transmural cecal perforation.
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Fig2
The histological examination confirmed the presence of a transmural cecal perforation with abscess caused by a piece of wood (toothpick) of 6 cm in length (Figure  2).