Bacteremia Caused by a Swallowed Toothpick Impacted in the Gastric Mucosa

Abstract

Although most ingested foreign bodies usually pass through the gastrointestinal tract asymptomatically, toothpick injury to the gastrointestinal tract is often associated with significant morbidity and mortality. Toothpick perforation of the gastrointestinal tract is frequently reported but, to the best of our knowledge, bacteremia caused by an impacted toothpick within the gastric mucosa has not yet been described. Here, we report the case of bacteremia caused by an accidentally swallowed toothpick. The toothpick was impacted deeply in the gastric mucosa and was first seen and localized on contrast-enhanced computed tomography (CT). CT scan is a very useful imaging technique in such situations since we lack typical and relevant physical findings or laboratory studies that go with accidentally swallowed objects, in this case a toothpick. Flexible endoscopy was successful in extracting the whole toothpick. In cases without free perforation, flexible endoscopy is the treatment of choice in toothpick removal from the upper gastrointestinal tract.

Successful diagnosis and treatment of ingested wooden toothpicks

“…[ 4 , 5 , 10 ] Complications of perforation include fistula, sepsis, bleeding, and even death. [ 1 , 11 ] The location that a toothpick lodges determines the symptom.…”

Accidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy: a case report

“…The duration of symptoms before diagnosis ranged from one day to nine months [ 2 ]. Toothpick ingestion may cause severe, sometimes fatal, internal injuries due to gastrointestinal perforation and migration to adjacent structures [ 2 , 4 , 7 ]. Diagnosis of toothpick injury can be quite difficult as patients frequently have vague symptoms with no specific physical findings [ 2 , 3 , 6 ].…”

“…Patients with ingested toothpicks in the gastrointestinal tract typically have no recollection of the event. Symptoms related to toothpick ingestion are often variable and non-specific [ 3 , 4 ]. In the current report, we describe the case of a 37-year-old Caucasian woman with an incidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy for symptomatic gall stones.…”

Trans-colonic foreign body penetration of the retro-hepatic vena cava. Report of a case and review of the literature

“…Approximately 80% of ingested foreign bodies pass through the gastrointestinal tract without any sequelae, 10–20% requires endoscopic removal and less than 1% requires surgical intervention [2] , [3] , [5] , [6] . Complications of foreign body ingestion include ulcer formation, lacerations, perforation, intestinal obstruction, aorto-esophageal and tracheo-esophageal fistula formation, and infection [7] , [8] , [9] , [10] , [11] , [12] .…”