An unusual cause of abdominal pain in an older woman.

ABSTRACT

Toothpick ingestion is an uncommon condition. It has been reported that an estimated incidence of 3.6 toothpick related injuries per 100,000 people per year. However, the incidence of toothpick-related gastrointestinal tract perforation is as high as 80%, with small bowel perforation accounting for 18% of cases. Common symptoms associated with toothpick ingestion include abdominal pain, fever, nausea, diarrhea, and constipation. However, it may lead to peritonitis, abscesses, and sepsis in severe cases. The diagnosis of toothpick ingestion is difficult. Only a minority (12%) of patients remember eating toothpicks and the sensitivity of computed tomography (CT) and endoscopy is 43% and 70%, respectively. When a toothpick penetrates the small intestine or is accompanied by other adverse events such as peritonitis, the vast majority of patients undergo surgery. Double-balloon enteroscopy (DBE) is not only an examination method for small intestinal diseases, but also an endoscopic treatment for the removal of sharp foreign bodies such as toothpicks. We report an elderly woman who was diagnosed as toothpick penetrated the jejunal wall and successfully retrieval under DBE. To our best knowledge, there is currently only one report of removing toothpick from the small intestine using DBE. We figured that DBE is a feasible, safe, and effective treatment when toothpicks penetrate the small intestinal wall without other adverse events based on our presentation.