Intramural Gastric Abscess Caused by a Toothpick Presenting as a Subepithelial Tumor

Abstract

In the present report, we describe an unusual case of an intramural gastric abscess caused by a foreign body, detected in the form of a subepithelial tumor. A 64-year-old woman was referred to our gastroenterology clinic for further evaluation of a gastric subepithelial tumor. The patient presented with a 1-month history of sustained dull epigastric pain. Esophagogastroduodenoscopy revealed an ill-demarcated, round, smooth, protruding lesion with a small central erosion on the great curvature of the proximal antrum. Endoscopic ultrasonography indicated the presence of an ovoid, heterogeneous, hypoechoic lesion with small echogenic foci located in the submucosa and muscularis propria layers. An abdominal computed tomography scan showed focal gastric wall thickening and regional lymph node enlargement. Endoscopic submucosal dissection was performed for definite diagnosis and management. Thus, we detected a toothpick and removed it using grasping forceps. The final diagnosis was an intramural gastric abscess caused by a toothpick.

Forgotten Swallowed Wooden Toothpick Detected on Ultrasound

“…7Y13 According to the literature, most patients do not have a recollection of having swallowed a toothpick. 7,9 Presenting clinical symptoms vary from epigastric pain (most commonly) to dysphagia, vomiting, chest pain, and pharyngeal discomfort. Up to 30% of patients will have no symptoms 4 and may remain undiagnosed for many years.…”

Advanced Gastric Cancer With Intramural Abscess: A Case Report of a Rare Clinicopathological Condition

“…GWA is one type of phlegmonous and suppurative gastritis, and most likely due to infection, through hematogenous infection or direct invasion by microorganisms such as mucosa injury or trauma (5). With regard to mucosa injury or trauma, most cases were reported to be caused by the endoscopic biopsy procedure, though penetrating trauma such as from toothpick or fish bone was also reported (6,7).…”

“…EUS has recently been reported to be a useful diagnostic modality for GWA (1,6) which is detected as a hypoechoic mass within the gastric wall (15). Moreover, the usefulness of an interventional EUS procedure for the treatment of GWA has been reported (1,10,15).…”

Diagnostic challenges in differentiating intramural gastric abscess from gastric cancer

“…The diagnosis of an intramural gastric abscess is often difficult. [ 5 , 6 , 7 , 8 ] It has a protruding appearance similar to that of subepithelial gastric neoplasms, such as a gastrointestinal stromal tumor (GIST), lipoma, neuroendocrine tumor (NET), and hematoma, under esophagogastroduodenoscopy (EGD). Computed tomography (CT) and endoscopic ultrasonography (EUS) often fail to reliably differentiate an intramural abscess from a malignancy, especially when the abscess lesion penetrates adjacent organs, or when a cancerous lesion of an adjacent organ invades the gastric wall to form a tumor-like mass.…”