The study was approved by the Institutional Review Board of the Dankook University Hospital and the informed consent was waived. A 47-year-old male was referred to our Emergency Department with recurrent pain in the right lower abdominal pain. He had received conservative treatment for 3 weeks at a private clinic under the impression that he was suffering from diverticulitis in the cecum. He had a history of pulmonary tuberculosis and hepatitis B and had undergone an appendectomy 10 years earlier. Physical examination revealed normal vital signs and mild tenderness of the right lower quadrant of the abdomen. Routine blood tests were normal except for elevated C-reactive protein (CRP) (6.33 mg/dL). Abdominopelvic computed tomography (CT) showed cecal wall thickening with pericecal fat infiltration and scanty ascites in the pelvis, suggestive of diverticulitis in the cecum (Fig. 1A). The patient was hospitalized in the Department of Gastroenterology and received conservative treatment for 2 weeks. The symptoms were much improved, but mild abdominal pain still remained, so abdominal ultrasonography (USG) was performed and showed a linear foreign body in the right lower abdominal wall (Fig. 1B); we decided to perform a laparoscopic examination. That examination revealed no evidence of fluid collection or bowel contents in the abdominal cavity, but it did reveal adhesion between the abdominal wall, the omentum, and the cecum (Fig. 1C). We performed adhesiolysis, but at first, we could not find the foreign body or any evidence of bowel perforation (Fig. 1D, E). Then, using a right lower abdominal skin incision, we found a toothpick embedded in the subcutaneous fat and muscle layer and removed it (Fig. 1F). Because of concerns about wound infection, the wound was left open for delayed closure. The patient was discharged seven days after the surgery without complications.

A 56-year-old male was referred to the Outpatient Department complaining of left lower abdominal pain that had been present for 3 weeks. He had received conservative treatment for 10 days at a private clinic under the impression of his having diverticulitis in the sigmoid colon. Because his symptoms had not improved very much, he visited our hospital for further evaluation. He had been diagnosed with hypertension 20 years earlier and had no history of surgery. The physical examination revealed normal vital signs and mild tenderness of the left lower quadrant of the abdomen. Routine blood tests were normal without leukocytosis or elevated CRP. Abdominopelvic CT showed wall thickening of the sigmoid colon and pericolic fat infiltration with a linear line in the left lower mesentery, suggestive of diverticulitis in the sigmoid colon with a suspicious fistulous tract (Fig. 2A). Colonoscopy revealed erythematous mucosal inflammation in the sigmoid colon. The toothpick was shown at the sigmoid colon, but was missed at that time (Fig. 2B). The patient received conservative treatment, and a follow-up CT was done 10 days after admission. In the follow-up CT, a linear high-density structure in the mesentery connected to the sigmoid colon was seen and was suspected of being a foreign body penetrating the sigmoid colon, so the patient was referred to the Surgery Department for operative management. An explo-laparotomy revealed a toothpick piercing the sigmoid colon with pericolic inflammation, so an anterior resection was performed (Fig. 2C). The patient was discharged nine days after the surgery without complications.