He was a young and fit pro athlete, but he came dangerously close to death when he accidentally swallowed a rather commonplace item: a toothpick.
The seemingly mundane toothpick wreaked havoc inside the 18-year-old man's body, where the object punctured the wall of his lower intestine and poked into an artery, according to a new report of the case, published Wednesday (Jan. 30) in The New England Journal of Medicine.
The injuries would eventually lead to life-threatening bleeding along with a bloodstream infection. However, the man didn't remember swallowing the toothpick, and it took weeks and visits to three hospitals before doctors figured out what was behind his mysterious symptoms, the report said. [11 Weird Things People Have Swallowed]
Worsening symptoms
The young man, whose identity was not released by the case-report authors, had been healthy when he left on a trip to the southeastern U.S.
While on the trip, however, he developed abdominal pain, fever, nausea and diarrhea that sent him to the emergency room. Doctors performed blood tests and a CT scan but didn't spot anything unusual, so they sent him back to his hotel after 5 hours.
During the next two weeks, the man's symptoms abated, but then the abdominal pain returned when he went on a trip to the western U.S. In addition, the man had back pain and bloody stools, and he again went to the ER. This time, an imaging scan revealed air and fluid in his large intestine. The ER doctors still weren't sure what was causing the man's symptoms, however, so they suggested he go to the doctor when he got back to his home in New England.
There, doctors at the Massachusetts General Hospital in Boston said the man should have a colonoscopy, but during the preparation for the procedure, the man experience fever and chills, along with profuse bleeding in his stools. Tests also revealed he had a bacterial infection in his blood.
Doctors were still able to perform the colonoscopy, and that's when they found it: a 2-inch (5 centimeters) toothpick poking into the wall of the man's large intestine.
The doctors were "stunned" to find the toothpick, since they hadn't seen it on imaging scans and the man hadn't reported thinking that he swallowed anything unusual, Dr. Fabian J. Scheid, an internist at Mass General who treated the patient, told The New York Times.
Doctors removed the toothpick with the help of an endoscope, a long, flexible tube with a camera attached. But the toothpick had also injured an artery, and once the object was removed, the man experienced "life-threatening" bleeding, the report said. He was rushed to the operating room, where he needed extensive surgery to repair the damage and stop the bleeding. [10 Strangest Medical Cases of 2018]
Dangerous if swallowed
Toothpicks are known to pose a serious risk of injury when swallowed. Indeed, in 2014, doctors from Germany published a review of 136 cases of people who swallowed toothpicks, finding that 80 percent of those patients experienced a puncture in their gut from the toothpick and nearly 10 percent died from their injuries.
Still, such serious injuries from toothpicks are uncommon. "It is rare for someone to get this kind of complication, to this degree, with toothpick ingestion," said Dr. Jefry Biehler, chairman of pediatrics at Nicklaus Children's Hospital in Miami, who was not involved in the New England case. Often, toothpicks can be removed without surgery, but it's still important for adults, or parents of children, to seek medical care if they or their children have swallowed a toothpick, Biehler said.
But if a person doesn't realize they've swallowed a toothpick, the problem can be difficult to diagnose. Wood toothpicks are often very difficult to see on imaging tests like X-rays or even ultrasounds, Biehler told Live Science.
The current case highlights the need for doctors "to keep an open mind" and to consider a broad range of diagnoses for someone who has abdominal pain without a clear cause, Biehler told Live Science. It also shows that "anything that can go into a mouth, somebody's going to swallow," he said. Small children in particular will swallow pretty much anything, and they should not be allowed to have toothpicks in their mouths, he said.
After being told about the toothpick, the New England man did recall eating a "sandwich that did not go down so well" before he became sick, The New York Times reported.
The man stayed in the hospital for 10 days and needed to take antibiotics for a month to treat his blood infection. He also underwent a long-term rehab program to be able to get back in shape for his sport, and seven months after his injury, he played in his first professional game, the report said.
Originally published on Live Science.
