Is An Ingested Toothpick a Health Hazard?

ingested toothpick
Colonoscopy showing (Panel A) blood throughout the sigmoid colon. Panels B and C show a 25 cm wooden toothpick, with evidence that it had eroded the colon wall. Panel D shows removed toothpick; Panel D demostrates pulsatile bleeding. The bleeding was addressed with placement of nine hemostatic clips and administration of a total of 10 ml of epinephrine (Panels F and G).

A young teenager suffers complications due to an ingested toothpick

An 18-year-old professional athlete unintentionally swallowed a wooden toothpick while having a sandwich during his trip to the southeast US for his athletic training. A day later, he presented to the emergency department with sudden onset of diarrhoea, mild postprandial nausea, fever, and pain in the right lower quadrant of the abdomen.

However, during his stay in the ER, he underwent a series of investigations and scans, but the doctors could not reach a specific diagnosis. Therefore, they stabilised and discharged him after 5 hours.

During the next 2 weeks, his symptoms improved. Although initially the pain and fever subsided, nausea persisted. During another training trip, his symptoms returned. He complained of pain, bloody stools, and high-grade fever. In the ER, he underwent an MRI which could not unveil the aetiology.

An internist advised him to return home and undergo further evaluation. Following the advice, he returned home and consulted an internist. The doctor advised him to have a colonoscopy. As a part of the bowel preparation prior to the colonoscopy, he took the bowel-prep regimen after which he had a bowel movement with a large amount of blood. He also experienced fever with chills and severe pain.

He was referred to a hospital where the doctors admitted him. Blood culture revealed bacteremia. However, there his condition worsened. His body temperature spiked to 105 degrees and he was tachycardic. Subsequently, the patient had rapid breathing and a confused mental status. The doctors suspected septicaemia.

 The doctors performed colonoscopy and this time they diagnosed him.

They found a toothpick lodged in his colon, piercing through his intestinal wall and into a neighbouring, large artery. They removed the toothpick. However, it led to profuse bleeding. The bleeding could not be controlled; therefore he underwent surgery to stem the life-threatening bleeding. Intraoperatively, the surgeons found that the toothpick had also slashed the right common iliac artery. They had to cut out a 3 cm chunk of the artery and they replaced it with tissue harvested from a vein in his leg.

A week later, the patient had recovered substantially. He was able to walk independently; however, for his professional game, he needed seven months of rehabilitation and training.

SOURCEThe New England Journal of Medicine
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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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