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8.99989 0 0 8.99989 53.85791 171.07391 Tm (complications.)Tj /F1 1 Tf 9.99989 0 0 9.99989 53.85831 141.35130 Tm (Discussion)Tj /F0 1 Tf 8.99989 0 0 8.99989 66.63831 124.85680 Tm [(A)20.24841 (fter)-423.72131 (the)-423.78235 (ingestion)-423.18726 (of)-423.66028 (foreign)-423.29407 (bodies)-423.23303 (only)-423.38562 (a)-423.58398 (few)-423.44666 (pa)]TJ 8.99989 0 0 8.99989 281.92110 124.86133 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 53.85751 114.05791 Tm 0.00011 Tc [(tients)-286.63635 (develop)-286.37695 (a)-286.86523 (bowel)-286.39221 (perforation,)-285.78186 (and)-286.46851 (nearly)-286.20911 (14%)-286.45325 (of)-286.43799 (all)]TJ 8.99989 0 0 8.99989 53.85751 103.25806 Tm [(patients)-326.70593 (require)-326.75171 (emergency)-326.35498 (surgery)]TJ 6 0 0 6 201.12350 106.25780 Tm -0.00011 Tc (14)Tj 8.99989 0 0 8.99989 210.67570 103.25790 Tm 0 Tc (.)Tj 8.99989 0 0 8.99989 66.63786 90.45830 Tm 0.00011 Tc [(The)-362.62512 (toothpicks)-362.03003 (most)-362.39624 (frequently)-361.89270 (caused)-362.13684 (injury)-362.16736 (to)-362.44202 (the)]TJ 8.99989 0 0 8.99989 53.85803 79.65845 Tm [(duodenum,)-231.39954 (and)-231.96411 (injury)-231.68945 (of)-231.97937 (the)-231.84204 (ileum)-231.70471 (was)-231.75049 (observed)-231.27747 (in)-231.76575 (9%)-231.73523 (of)]TJ 8.99989 0 0 8.99989 304.72552 711.18369 Tm [(all)-270.14160 (patients)-269.57703 (only)]TJ 6 0 0 6 370.55991 714.18130 Tm 0 Tc (5)Tj 8.99989 0 0 8.99989 373.83591 711.18140 Tm 0.00011 Tc [(.)-270.12634 (But,)-269.77539 (mortality)-269.37866 (after)-269.63806 (toothpick)-269.25659 (perfora)]TJ 8.99989 0 0 8.99989 532.78297 711.17604 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72392 700.38155 Tm 0.00011 Tc [(tion)-326.62964 (of)-326.70593 (the)-326.56860 (intestines)-326.00403 (is)-326.56860 (quite)-326.30920 (high,)-326.17188 (up)-326.43127 (to)-326.40076 (18%)]TJ 6 0 0 6 493.07100 703.38181 Tm 0 Tc (5)Tj 8.99989 0 0 8.99989 496.34700 700.38200 Tm (.)Tj 8.99989 0 0 8.99989 317.50378 687.58240 Tm 0.00011 Tc [(In)-611.81641 (our)-611.69434 (case)-611.52649 (intestinal)-611.02295 (perforation)-610.82458 (was)-611.38916 (completely)]TJ 8.99989 0 0 8.99989 304.72395 676.78255 Tm [(asymptomatic.)-440.93323 (The)-441.68091 (patient)-441.42151 (had)-441.68091 (acute)-441.43677 (appendicitis)-440.81116 (and)]TJ 8.99989 0 0 8.99989 304.72395 665.98270 Tm [(ileal)-361.02295 (perforation)-360.32104 (was)-360.88562 (discovered)-360.27527 (during)-360.53467 (laparoscopic)-359.90906 (ex)]TJ 8.99989 0 0 8.99989 532.78397 665.97816 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72395 655.18285 Tm 0.00011 Tc [(ploration)-239.68506 (in)-240.26489 (the)-240.12756 (beginning)-239.44092 (of)-240.02075 (laparoscopic)-239.10522 (appendectomy)135.62012 (.)]TJ 8.99989 0 0 8.99989 304.72395 644.38300 Tm [(Despite)-255.99670 (the)-256.27136 (high)-256.11877 (mortality)-255.73730 (rates)-255.98145 (reported)-255.61523 (after)-255.85938 (toothpick)]TJ 8.99989 0 0 8.99989 304.72395 633.58315 Tm [(perforation)-262.77161 (of)-263.44299 (the)-263.30566 (intestines,)-262.61902 (published)-262.64954 (cases)-262.96997 (and)-263.06152 (our)-263.01575 (ex)]TJ 8.99989 0 0 8.99989 532.78397 633.57957 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72395 622.78426 Tm 0.00011 Tc [(perience)-321.59424 (indicate)-321.62476 (that)-321.88416 (small)-321.73157 (bowel)-321.56372 (perforation)-321.06018 (following)]TJ 8.99989 0 0 8.99989 304.72395 611.98441 Tm [(the)-361.02295 (ingestion)-360.45837 (of)-360.91614 (a)-361.00769 (toothpick)-360.32104 (or)-360.79407 (other)-360.54993 (foreign)-360.27527 (bodies)-360.30579 (can)]TJ 8.99989 0 0 8.99989 304.72395 601.18456 Tm [(safely)-354.70581 (be)-354.98047 (treated)-354.52271 (via)-354.79736 (minimally)-354.20227 (invasive)-354.23279 (approach,)-353.92761 (even)]TJ 8.99989 0 0 8.99989 304.72395 590.38470 Tm [(in)-326.73645 (patients)-326.15662 (with)-326.52283 (peritonitis)-325.83618 (or)-326.50757 (comorbid)-325.82092 (disseases)]TJ 6 0 0 6 508.80470 593.38770 Tm -0.00011 Tc (610)Tj 8.99989 0 0 8.99989 521.63290 590.38780 Tm 0 Tc (.)Tj /F1 1 Tf 9.99989 0 0 9.99989 304.72440 206.31461 Tm 0.00011 Tc (Conclusion)Tj /F0 1 Tf 8.99989 0 0 8.99989 317.50439 189.82010 Tm [(In)-290.83252 (our)-290.67993 (opinion,)-290.13062 (laparoscopic)-289.70337 (approach)-289.91699 (is)-290.51208 (the)-290.35950 (best)-290.23743 (way)]TJ 8.99989 0 0 8.99989 304.72456 179.02025 Tm [(for)-279.03748 (treatment)-278.45764 (of)-279.03748 (acute)-278.77808 (appendicitis)-278.06091 (and,)-278.64075 (like)-278.68652 (in)-278.77808 (this)-278.64075 (case,)]TJ 8.99989 0 0 8.99989 304.72456 168.22040 Tm [(it)-327.16370 (gives)-326.81274 (you)-326.87378 (the)-326.82800 (opportunity)-326.01929 (to)-326.81274 (diagnose)-326.21765 (and)-326.59912 (treat)-326.44653 (other)]TJ 8.99989 0 0 8.99989 304.72456 157.42055 Tm [(diseases)-221.49658 (and)-221.77124 (conditions)-221.17615 (that)-221.63391 (may)-221.58813 (have)-221.46606 (been)-221.40503 (overlooked)]TJ 6 0 0 6 526.69870 160.42171 Tm 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-0.00011 Tc [(KT)145.47729 (,)-366.33301 (W)68.74084 (orld)-366.37878 (J)-366.13464 (Surg,)-366.37878 (20)-366.02783 (\(1996\))-366.27197 (1001.)-366.02783 ()-365.57007 (2)1.28174 (.)-365.61584 (SCHW)60.76050 (A)1.48010 (R)35.43091 (T)1.55640 (Z)-365.31067 (G)1.73950 (F)189.46838 (,)-365.12756 (POLSK)26.85547 (Y)-364.89868 (H)2.04468 (S)18.78357 (,)]TJ 6.99980 0 0 6.99980 59.52733 677.17993 Tm [(Ann)-227.11182 (Surg,)-227.06604 (42)-226.71509 (\(1976\))-227.06604 (236.)-226.77612 ()-226.30310 (3)1.03760 (.)-226.33362 (S)1.09863 (ELIV)77.62146 (ANO)18.02063 (V)-225.95215 (V)223.48022 (,)-225.90637 (SHELDON)-226.53198 (GF)189.54468 (,)-225.55542 (C)1.78528 (ELLO)-225.96741 (JP)]TJ 6.99980 0 0 6.99980 288.57410 677.17993 Tm 0 Tc (,)Tj 6.99980 0 0 6.99980 59.52733 668.78020 Tm -0.00011 Tc [(CRAS)-17.07458 (S)-427.44446 (R)0.61035 (A,)-427.71912 (Ann)-427.52075 (Surg,)-427.58179 (199)-427.27661 (\(1984\))-427.42920 (187.)-427.12402 ()-426.74255 (4)1.40381 (.)-426.78833 (W)1.57166 (EBB)-427.01721 (W)61.34033 (A)1.67847 (,)-426.51367 (G)1.86157 (astrointest)]TJ 6.99980 0 0 6.99980 59.52733 660.38046 Tm [(Endosc,)-261.61194 (41)-261.06262 (\(1995\))-261.30676 (39.)-260.92529 ()-260.57434 (5)0.96130 (.)-260.63538 (L)1.02234 (I)-260.66589 (S)1.09863 (F)188.91907 (,)-260.39124 (ENDER)-260.87952 (K)1.48010 (,)-260.31494 (J)-260.10132 (Emerg)-260.52856 (Med,)-260.29968 (23)-259.93347 (\(2002\))-260.17761 (35.)]TJ 6.99980 0 0 6.99980 59.52733 651.98073 Tm -0.00020 Tc [()-683.13599 (6)0.41199 (.)-683.18176 (HEBRA)-683.47168 (A,)-682.89185 (D)17.79175 (A)60.51636 (VIDOFF)-683.21228 (A)1.06812 (M,)-682.67822 (AHMAD)-682.75452 (S)18.40210 (,)-681.97632 (STOCKMANN)-683.02917 (PT)146.88110 (,)]TJ 6.99980 0 0 6.99980 59.52733 643.58099 Tm -0.00011 Tc [(ST)60.05859 (AFFORD)-243.82019 (PW)179.96216 (,)-242.93518 (J)-243.01147 (Laparoendosc)-243.89648 (Surg,)-242.95044 (968)-242.67578 (\(1996\))-242.82837 (S95.)-242.50793 ()-242.15698 (7)1.67847 (.)-242.21802 (IANNELI)-242.67578 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(rates)-255.06592 (reported)-254.62341 (after)-254.82178 (toothpick)]TJ 8.99989 0 0 8.99989 304.72395 633.58315 Tm [(perforation)-262.03918 (of)-262.69531 (the)-262.51221 (intestines,)-261.73401 (published)-261.68823 (cases)-261.94763 (and)-262.00867 (our)-261.93237 (ex)]TJ 8.99989 0 0 8.99989 532.78397 633.57957 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72395 622.78426 Tm 0.00011 Tc [(perience)-320.89233 (indicate)-320.84656 (that)-321.06018 (small)-320.86182 (bowel)-320.63293 (perforation)-320.02258 (following)]TJ 8.99989 0 0 8.99989 304.72395 611.98441 Tm [(the)-360.35156 (ingestion)-359.71069 (of)-360.13794 (a)-360.21423 (toothpick)-359.45129 (or)-359.89380 (other)-359.60388 (foreign)-359.25293 (bodies)-359.22241 (can)]TJ 8.99989 0 0 8.99989 304.72395 601.18456 Tm [(safely)-354.01917 (be)-354.26331 (treated)-353.74451 (via)-353.98865 (minimally)-353.30200 (invasive)-353.25623 (approach,)-352.85950 (even)]TJ 8.99989 0 0 8.99989 304.72395 590.38470 Tm [(in)-326.08032 (patients)-325.42419 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(laparoscopy)-393.92090 (should)-394.19556 (only)-394.28711 (be)-394.43970 (preformed)-393.55469 (by)-394.19556 (experi)]TJ 8.99989 0 0 8.99989 532.78366 114.22789 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 103.42351 Tm 0.00011 Tc [(enced)-490.03601 (surgeons)-489.56299 (in)-490.11230 (several)-489.56299 (laparoscopic)-488.84583 (procedures)-488.83057 (be)]TJ 8.99989 0 0 8.99989 532.78270 103.42804 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 92.62366 Tm 0.00011 Tc [(cause)-281.61621 (different)-281.17371 (diseases)-281.12793 (can)-281.46362 (be)-281.49414 (diagnosed)-280.65491 (during)-280.80750 (routine)]TJ 8.99989 0 0 8.99989 304.72365 81.82381 Tm [(laparoscopic)-325.13428 (exploration)-325.01221 (or)-325.66833 (procedure)]TJ 6 0 0 6 459.89120 84.82570 Tm -0.00011 Tc (12)Tj 8.99989 0 0 8.99989 466.44321 81.82570 Tm 0 Tc (.)Tj ET /CS0 CS 0.13699 0.12199 0.12500 SCN 0.21600 w 2.61301 M 53.85800 734.44299 m 535.74800 734.44299 l S /CS0 CS 1 1 1 SCN 53.85800 735.65900 m 535.74800 735.65900 l S q 64.50600 720 209.72501 -141.73000 re W n q 209.78931 0 0 -141.73030 64.50580 720 cm /X0 Do Q Q Q BT /F2 1 Tf 7.99980 0 0 7.99980 79.85060 566.50841 Tm -0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /CS0 CS 1 1 1 SCN 0.21600 w 2.61301 M /GS0 gs [(Fig.)-328.67432 (1.)-328.44543 (Acute)-328.96423 (appendicitis)-329.97131 (and)-329.16260 (sticking)-329.86450 (toothpick.)]TJ ET q 64.60600 547.14799 209.52499 -153.06799 re W n q 209.76961 0 0 -153.06870 64.60580 547.14841 cm /X1 Do Q Q Q BT /F2 1 Tf 7.99980 0 0 7.99980 96.42950 382.31830 Tm -0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /CS0 CS 1 1 1 SCN 0.21600 w 2.61301 M /GS0 gs [(Fig.)-328.79639 (2.)-328.53699 (Appendicle)-329.80347 (stump)-329.36096 (and)-329.28467 (toothpick.)]TJ ET q 323.92200 567.55499 192.62399 -138.89500 re W n q 192.65320 0 0 -138.89571 323.92230 567.55470 cm /X2 Do Q Q Q BT /F2 1 Tf 7.99980 0 0 7.99980 355.52690 416.89790 Tm -0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /CS0 CS 1 1 1 SCN 0.21600 w 2.61301 M /GS0 gs [(Fig.)-330.41382 (3.)-330.18494 (A)-330.10864 (pulling)-330.90210 (out)-330.68848 (of)-330.55115 (a)-330.47485 (toothpick.)]TJ ET q 325.50999 395.33800 189.44800 -141.73000 re W n q 189.54460 0 0 -141.73030 325.51030 395.33780 cm /X3 Do Q Q Q BT /F2 1 Tf 7.99980 0 0 7.99980 365.51990 241.84630 Tm -0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /CS0 CS 1 1 1 SCN 0.21600 w 2.61301 M /GS0 gs [(Fig.)-330.44434 (4.)-330.21545 (A)-330.16968 (pulled)-330.82581 (out)-330.71899 (toothpick.)]TJ /F0 1 Tf 7.99980 0 0 7.99980 53.85831 737.63200 Tm [(Z)22.12524 (.)-328.06396 (P)52.07825 (erko)-328.61328 (et)-328.38440 (al.:)-328.65906 (Acute)-329.02527 (Appendicitis)-330.00183 (and)-329.22363 (Ileal)-329.40674 (P)51.13220 (erforation)-330.18494 (with)-329.71191 (a)-329.46777 (T)43.19763 (oothpick,)-329.71191 (C)-1.96838 (oll.)-330.23071 (Antropol.)]TJ /F1 1 Tf 7.99980 0 0 7.99980 385.02844 737.63200 Tm (32)Tj /F0 1 Tf 7.99980 0 0 7.99980 396.97701 737.63200 Tm [(\(2008\))-330.79529 (1:)-330.45959 (307)]TJ 7.99980 0 0 7.99980 445.22240 737.63200 Tm 0 G 1 w 10 M /GS1 gs [(30)-2.85339 (9)]TJ /F0 8.99989 Tf 1.00002 0 0 1.00002 53.85831 52.10220 Tm 0.00011 Tc /CS0 CS 1 1 1 SCN 0.21600 w 2.61301 M /GS0 gs (308)Tj ET endstream endobj 325 0 obj <> endobj 326 0 obj <> endobj 327 0 obj <> endobj 328 0 obj <> endobj 329 0 obj <> stream BT /F0 1 Tf 8.99989 0 0 8.99989 53.85791 225.07317 Tm 0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /GS0 gs [(tient)-246.59729 (was)-246.62781 (febrile,)-246.18530 (up)-246.55151 (to)-246.47522 (38.)-246.32263 ()0.68665 (C)-246.38367 (and)-246.10901 (treated)-245.77332 (with)-245.89539 (two)-245.91064 (anti)]TJ ET endstream endobj 330 0 obj <> endobj 331 0 obj <> endobj 332 0 obj <> endobj 333 0 obj <> endobj 334 0 obj <> endobj 335 0 obj <> stream q q q q BT /F0 1 Tf 8.99989 0 0 8.99989 53.85831 345.86900 Tm 0.00011 Tc /CS0 cs 0.13699 0.12199 0.12500 scn /GS0 gs [(mesoappendix)-528.24402 (division)-528.57971 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[(form)-312.08801 (ileal)-311.99646 (wall)-311.95068 (was)-311.84387 (pulled)-311.52344 (out)-311.67603 (\(Figure)-311.24878 (3)-311.70654 (and)-311.43188 (4\).)-311.46240 (The)-311.29456 (site)]TJ 8.99989 0 0 8.99989 53.85791 281.07025 Tm [(of)-444.96155 (perforation)-444.04602 (was)-444.54956 (sutured)-444.19861 (with)-444.30542 (two)-444.35120 (polyglactin)-443.52722 (intra)]TJ 8.99989 0 0 8.99989 281.92067 281.07204 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 53.85791 270.27040 Tm 0.00011 Tc [(corporally)-330.39856 (knotted)-330.45959 (stitches.)-330.20020 (Subsequently)-329.55933 (we)-330.39856 (preformed)]TJ 8.99989 0 0 8.99989 53.85791 259.47055 Tm [(a)-327.25525 (thorough)-326.37024 (lavage)-326.58386 (of)-326.81274 (abdominal)-325.94299 (cavity)134.68933 (.)]TJ 8.99989 0 0 8.99989 66.63774 246.67094 Tm [(A)20.40100 (fter)-271.83533 (the)-271.77429 (operation,)-270.98083 (the)-271.53015 (patient)-271.10291 (was)-271.20972 (treated)-270.88928 (on)-271.22498 (a)-271.30127 (gen)]TJ 8.99989 0 0 8.99989 281.92149 246.67369 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 53.85791 235.87206 Tm 0.00011 Tc [(eral)-260.92529 (surgical)-260.46753 (ward.)-260.54382 (On)-260.68115 (the)-260.62012 (first)-260.46753 (postoperative)-259.52148 (day)-260.25391 (the)-260.16235 (pa)]TJ 8.99989 0 0 8.99989 281.92149 235.87480 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 281.92067 225.07591 Tm (-)Tj 8.99989 0 0 8.99989 53.85791 214.27332 Tm 0.00011 Tc [(biotics)-570.37354 (\(metronidasole)-569.39697 (and)-570.20569 (ceftriaxone)-569.41223 (sodium\).)-569.44275 (A)21.22498 (fter)]TJ 8.99989 0 0 8.99989 53.85791 203.47346 Tm [(second)-254.16565 (day)-254.30298 (the)-254.33350 (patient)-253.78418 (was)-254.02832 (afebrile)-253.57056 (and)-253.81470 (completely)-253.12805 (toler)]TJ 8.99989 0 0 8.99989 281.92067 203.47621 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 53.85791 192.67361 Tm 0.00011 Tc [(ated)-253.49426 (peroral)-253.08228 (diet.)-253.18909 (On)-253.31116 (postoperative)-252.16675 (day)-252.91443 (3)-253.08228 (the)-252.82288 (patient)-252.39563 (was)]TJ 8.99989 0 0 8.99989 53.85791 181.87376 Tm [(released)-416.42761 (from)-416.64124 (the)-416.67175 (hospital)-416.13770 (and)-416.35132 (fully)-416.24451 (recovered)-415.66467 (without)]TJ 8.99989 0 0 8.99989 53.85791 171.07391 Tm (complications.)Tj /F1 1 Tf 9.99989 0 0 9.99989 53.85831 141.35130 Tm (Discussion)Tj /F0 1 Tf 8.99989 0 0 8.99989 66.63831 124.85680 Tm [(A)20.40100 (fter)-423.53821 (the)-423.56873 (ingestion)-422.88208 (of)-423.32458 (foreign)-422.89734 (bodies)-422.77527 (only)-422.88208 (a)-423.06519 (few)-422.89734 (pa)]TJ 8.99989 0 0 8.99989 281.92110 124.86133 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 53.85751 114.05791 Tm 0.00011 Tc [(tients)-286.46851 (develop)-286.14807 (a)-286.62109 (bowel)-286.08704 (perforation,)-285.36987 (and)-286.02600 (nearly)-285.70557 (14%)-285.90393 (of)-285.87341 (all)]TJ 8.99989 0 0 8.99989 53.85751 103.25806 Tm [(patients)-326.52283 (require)-326.50757 (emergency)-326.00403 (surgery)]TJ 6 0 0 6 201.12350 106.25780 Tm -0.00011 Tc (14)Tj 8.99989 0 0 8.99989 210.67570 103.25790 Tm 0 Tc (.)Tj 8.99989 0 0 8.99989 66.63786 90.45830 Tm 0.00011 Tc [(The)-362.45728 (toothpicks)-361.77063 (most)-362.09106 (frequently)-361.48071 (caused)-361.66382 (injury)-361.63330 (to)-361.89270 (the)]TJ 8.99989 0 0 8.99989 53.85803 79.65845 Tm [(duodenum,)-231.20117 (and)-231.71997 (injury)-231.38428 (of)-231.65894 (the)-231.49109 (ileum)-231.30798 (was)-231.30798 (observed)-230.75867 (in)-231.23169 (9%)-231.17065 (of)]TJ 8.99989 0 0 8.99989 304.72552 711.18369 Tm [(all)-269.48547 (patients)-268.85986 (only)]TJ 6 0 0 6 370.55991 714.18130 Tm 0 Tc (5)Tj 8.99989 0 0 8.99989 373.83591 711.18140 Tm 0.00011 Tc [(.)-269.34814 (But,)-268.95142 (mortality)-268.46313 (after)-268.67676 (toothpick)-268.21899 (perfora)]TJ 8.99989 0 0 8.99989 532.78297 711.17604 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72392 700.38155 Tm 0.00011 Tc [(tion)-325.95825 (of)-326.01929 (the)-325.83618 (intestines)-325.19531 (is)-325.72937 (quite)-325.42419 (high,)-325.24109 (up)-325.46997 (to)-325.40894 (18%)]TJ 6 0 0 6 493.07100 703.38181 Tm 0 Tc (5)Tj 8.99989 0 0 8.99989 496.34700 700.38200 Tm (.)Tj 8.99989 0 0 8.99989 317.50378 687.58240 Tm 0.00011 Tc [(In)-611.12976 (our)-610.99243 (case)-610.74829 (intestinal)-610.15320 (perforation)-609.84802 (was)-610.38208 (completely)]TJ 8.99989 0 0 8.99989 304.72395 676.78255 Tm [(asymptomatic.)-440.17029 (The)-440.87219 (patient)-440.55176 (had)-440.76538 (acute)-440.47546 (appendicitis)-439.72778 (and)]TJ 8.99989 0 0 8.99989 304.72395 665.98270 Tm [(ileal)-360.35156 (perforation)-359.54285 (was)-360.07690 (discovered)-359.35974 (during)-359.55811 (laparoscopic)-358.82568 (ex)]TJ 8.99989 0 0 8.99989 532.78397 665.97816 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72395 655.18285 Tm 0.00011 Tc [(ploration)-238.96790 (in)-239.53247 (the)-239.36462 (beginning)-238.58643 (of)-239.13574 (laparoscopic)-238.11340 (appendectomy)136.73401 (.)]TJ 8.99989 0 0 8.99989 304.72395 644.38300 Tm [(Despite)-255.29480 (the)-255.53894 (high)-255.34058 (mortality)-254.88281 (rates)-255.06592 (reported)-254.62341 (after)-254.82178 (toothpick)]TJ 8.99989 0 0 8.99989 304.72395 633.58315 Tm [(perforation)-262.03918 (of)-262.69531 (the)-262.51221 (intestines,)-261.73401 (published)-261.68823 (cases)-261.94763 (and)-262.00867 (our)-261.93237 (ex)]TJ 8.99989 0 0 8.99989 532.78397 633.57957 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72395 622.78426 Tm 0.00011 Tc [(perience)-320.89233 (indicate)-320.84656 (that)-321.06018 (small)-320.86182 (bowel)-320.63293 (perforation)-320.02258 (following)]TJ 8.99989 0 0 8.99989 304.72395 611.98441 Tm [(the)-360.35156 (ingestion)-359.71069 (of)-360.13794 (a)-360.21423 (toothpick)-359.45129 (or)-359.89380 (other)-359.60388 (foreign)-359.25293 (bodies)-359.22241 (can)]TJ 8.99989 0 0 8.99989 304.72395 601.18456 Tm [(safely)-354.01917 (be)-354.26331 (treated)-353.74451 (via)-353.98865 (minimally)-353.30200 (invasive)-353.25623 (approach,)-352.85950 (even)]TJ 8.99989 0 0 8.99989 304.72395 590.38470 Tm [(in)-326.08032 (patients)-325.42419 (with)-325.74463 (peritonitis)-324.96643 (or)-325.60730 (comorbid)-324.84436 (disseases)]TJ 6 0 0 6 508.80470 593.38770 Tm -0.00011 Tc (610)Tj 8.99989 0 0 8.99989 521.63290 590.38780 Tm 0 Tc (.)Tj /F1 1 Tf 9.99989 0 0 9.99989 304.72440 206.31461 Tm 0.00011 Tc (Conclusion)Tj /F0 1 Tf 8.99989 0 0 8.99989 317.50439 189.82010 Tm [(In)-290.16113 (our)-289.96277 (opinion,)-289.35242 (laparoscopic)-288.80310 (approach)-288.94043 (is)-289.52026 (the)-289.32190 (best)-289.16931 (way)]TJ 8.99989 0 0 8.99989 304.72456 179.02025 Tm [(for)-278.38135 (treatment)-277.70996 (of)-278.27454 (acute)-277.95410 (appendicitis)-277.13013 (and,)-277.67944 (like)-277.67944 (in)-277.75574 (this)-277.57263 (case,)]TJ 8.99989 0 0 8.99989 304.72456 168.22040 Tm [(it)-326.52283 (gives)-326.12610 (you)-326.14136 (the)-326.06506 (opportunity)-325.14954 (to)-325.92773 (diagnose)-325.24109 (and)-325.59204 (treat)-325.39368 (other)]TJ 8.99989 0 0 8.99989 304.72456 157.42055 Tm [(diseases)-220.79468 (and)-221.03882 (conditions)-220.35217 (that)-220.76416 (may)-220.67261 (have)-220.52002 (been)-220.41321 (overlooked)]TJ 6 0 0 6 526.69870 160.42171 Tm -0.00011 Tc (11)Tj 8.99989 0 0 8.99989 533.25070 157.42180 Tm 0 Tc (.)Tj 8.99989 0 0 8.99989 304.72365 146.62195 Tm 0.00011 Tc [(W)81.40564 (e)-235.38208 (propose)-234.63440 (that)-234.84802 (diagnostic)-234.19189 (laparoscopy)-233.87146 (should)-234.16138 (be)-234.49707 (consid)]TJ 8.99989 0 0 8.99989 532.78270 146.62552 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 135.82210 Tm 0.00011 Tc [(ered)-224.85352 (in)-225.09766 (all)-224.96033 (patients)-224.30420 (presenting)-223.93799 (with)-224.44153 (acute)-224.24316 (abdominal)-223.57178 (pain)]TJ 8.99989 0 0 8.99989 304.72365 125.02225 Tm [(that)-395.96558 (requires)-395.49255 (surgical)-395.35522 (intervention.)-394.60754 (Nonetheless,)-394.48547 (emer)]TJ 8.99989 0 0 8.99989 532.78366 125.02678 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 114.22336 Tm 0.00011 Tc [(gency)-394.62280 (laparoscopy)-393.92090 (should)-394.19556 (only)-394.28711 (be)-394.43970 (preformed)-393.55469 (by)-394.19556 (experi)]TJ 8.99989 0 0 8.99989 532.78366 114.22789 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 103.42351 Tm 0.00011 Tc [(enced)-490.03601 (surgeons)-489.56299 (in)-490.11230 (several)-489.56299 (laparoscopic)-488.84583 (procedures)-488.83057 (be)]TJ 8.99989 0 0 8.99989 532.78270 103.42804 Tm 0 Tc (-)Tj 8.99989 0 0 8.99989 304.72365 92.62366 Tm 0.00011 Tc [(cause)-281.61621 (different)-281.17371 (diseases)-281.12793 (can)-281.46362 (be)-281.49414 (diagnosed)-280.65491 (during)-280.80750 (routine)]TJ 8.99989 0 0 8.99989 304.72365 81.82381 Tm [(laparoscopic)-325.13428 (exploration)-325.01221 (or)-325.66833 (procedure)]TJ 6 0 0 6 459.89120 84.82570 Tm -0.00011 Tc (12)Tj 8.99989 0 0 8.99989 466.44321 81.82570 Tm 0 Tc (.)Tj ET /CS0 CS 0.13699 0.12199 0.12500 SCN 0.21600 w 2.61301 M 53.85800 734.44299 m 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00000 n 0000293746 00000 n 0000306519 00000 n 0000306613 00000 n 0000306670 00000 n 0000306706 00000 n 0000306755 00000 n 0000306819 00000 n trailer < <722E5367792EB8BB5B3A32DE1FF58F84>] >> startxref 319637 %%EOF