{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T08:41:22Z","timestamp":1782549682118,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ingestion of plant material is an unusual cause of small-bowel perforation and can have a clinical appearance similar to acute appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description<\/jats:title>\n                    <jats:p>\n                      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\u202fmm, 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\n                      <jats:italic>Gnetum gnemon<\/jats:italic>\n                      var.\n                      <jats:italic>tenerum<\/jats:italic>\n                      , an edible plant. The fragment was removed, the ileal defect was closed primarily, and appendectomy was performed. The postoperative course was uncomplicated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1713022","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T06:28:00Z","timestamp":1764311280000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A sharp plant stem causing terminal ileal perforation with clinical presentation resembling acute appendicitis: a case 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