CASE REPORT article
Front. Med.
Sec. Gastroenterology
A Sharp Plant Stem Causing Terminal Ileal Perforation with Clinical Presentation Resembling Acute Appendicitis: A Case Report
Provisionally accepted
Pirada Yincharoen
Weeratian Tawanwongsri*- School of Medicine, Walailak University, Thasala, Thailand
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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, needlelike 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.
Keywords: Foreign Bodies, Intestinal Perforation, Appendicitis, Plants, Abdominal Pain, case report
Received: 25 Sep 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Yincharoen and Tawanwongsri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weeratian Tawanwongsri, weeratian.ta@gmail.com
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