Bowel perforation is an emergency condition that requires critical thinking and readily intervention; nevertheless, on occasions, its presentation can be challenging to diagnose. Several etiologies could cause bowel perforation, including obstruction, mass, inflammation, ischemia, etc. On rare occasions, a foreign body could be the cause of perforation, which mandates a detailed history and focused review of the images when the patient’s condition allows. We report a case of ileal perforation caused by an ingested wooden toothpick that was suspected on the CT images, which the patient has no memory of ingesting.

Traumatic Brain Injuries (TBIs) pose a significant global health burden, with high mortality and long-term disability rates. This retrospective cohort study investigates the implementation and impact of the Brain Trauma Foundation (BTF) guidelines on TBI management in a Saudi Arabian tertiary care center. Data from the pre-implementation (2012) and post-implementation (2022) of BTF guidelines periods were compared. The patient demographics, injury severity, guideline adherence, and outcomes were analyzed. The results revealed a 33% increase in severe TBI cases from 2012 to 2022, possibly due to the development of a well-established trauma system designed to manage such cases. More importantly, implementing the BTF guidelines led to a marked improvement in patient outcomes. Compliance with guidelines, including the avoidance of hypoxia and hypotension, hyperosmolar therapy, and DVT prophylaxis significantly increased post-implementation. Mortality rates decreased from 45.4% to 14.2%, accompanied by a reduction in the intensive care unit (ICU) length of stay and an increase in the hospital length of stay. A comparison with international trauma centers highlights the importance of protocol-based management in improving the TBI outcomes and reducing the mortality—factors such as specialist-led care, institutional policies, and increased resources influenced guideline adherence and patient care. This study underscores the critical role of evidence-based guidelines in optimizing TBI management and emphasizes the need for their widespread implementation in clinical practice. In conclusion, this study demonstrates the substantial impact of BTF guidelines on enhancing TBI patient outcomes in a Saudi Arabian tertiary care center. The implementation of these guidelines resulted in a significant reduction in mortality and in an improved adherence to the best practices in TBI management, highlighting the importance of evidence-based protocols in optimizing patient care and outcomes.