Pages of Surgery #2: Toothpicks

A word of caution when chugging drinks and/or chewing toothpicks…

This particular older female swallowed a whole toothpick along with her happy hour Martini.

My first instinct was to red-line for surgery right away. However, although the page said “perforated,” our own review of the CT images found no air or fluid leaking out of the colon (a lesson here for the medical students: always look at your own images, don’t blindly trust the initial read).

So, instead, we gave her a few liters of laxative—with close surgical observation, of course—and removed it with colonoscopy. The toothpick punched a small hole through the inner layer of the colon, but didn’t go all the way through. She did great afterwards and didn’t need surgery.

A recent review of 136 swallowed toothpicks found that only half of the toothpicks that made it to the colon underwent surgery; the other half were treated with colonoscopies.

Here’s a cool infographic from the same study showing where toothpicks will be found if swallowed:

Screen Shot 2016-06-03 at 10.13.32 PM

Credit:

Steinbach, Catherine, et al. “Accidentally ingested toothpicks causing severe gastrointestinal injury: a practical guideline for diagnosis and therapy based on 136 case reports.” World journal of surgery 38.2 (2014): 371-377.
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