The following case is reported because of the unique presentation and diagnostic problem the patient presented. This is the first reported instance of emphysema of the leg caused by toothpick perforation, and the first case resulting from perforation of the small intestine.
Report of a Case
A 51-year-old white male bartender, was admitted to Milwaukee County General Hospital on Dec 1, 1967, because of increasing lethargy. He had been in good health until five days prior to admission when he developed diarrhea, vomiting, and malaise. Within 24 hours, his appetite improved and he experienced no further gastrointestinal symptoms. He continued to be weak and fell two days prior to admission but sustained no apparent injury. On the morning of admission, he appeared lethargic and, within six hours, he was unresponsive. His only previous hospitalization was two years earlier for treatment of chronic dermatitis of his right lower leg.On admission,