A sharp plant stem causing terminal ileal perforation with clinical presentation resembling acute appendicitis: a case report.

INTRODUCTION

Ingestion of plant material is an unusual cause of small-bowel perforation and can have a clinical appearance similar to acute appendicitis.

CASE DESCRIPTION: A 40-year-old Thai man presented with a 1-day history of right lower quadrant pain and low-grade fever. Laboratory testing showed leukocytosis. Contrast-enhanced computed tomography (CT) demonstrated a mildly dilated appendix, 7 mm, without periappendiceal fat stranding, free air, abscess, or visible foreign body. Because localized peritonism persisted despite equivocal imaging, exploratory laparotomy via a Lanz incision was undertaken. A 2.5-cm, needle-like wooden fragment was palpated within the terminal ileum, causing a localized perforation; it was subsequently identified as the lateral stem of Gnetum gnemon var. tenerum, an edible plant. The fragment was removed, the ileal defect was closed primarily, and appendectomy was performed. The postoperative course was uncomplicated.

CONCLUSION

This case illustrates the limitations of imaging in the case of small-bowel perforation, and contributes to the literature on plant material ingestion as a cause of acute abdomen in the context of regions where such foods are consumed.