Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations

ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

Toothpick Colon Injury Mimicking Colonic Diverticulitis

Although toothpick ingestion is rare, it can lead to fatal complications in the gastrointestinal tract. Diagnosing toothpick ingestion is difficult because most patients do not recall swallowing one. We report 2 cases of toothpick-ingestion-induced colon injury, mimicking diverticulitis. The first patient was a 47-year-old male who had received conservative treatment under the impression of his having diverticulitis in the cecum. Ultrasonography revealed a linear foreign body in the right lower abdomen; a subsequent laparoscopic examination revealed inflammation around the cecum, but no evidence of bowel perforation. A thorough investigation revealed a toothpick embedded in the subcutaneous fat and muscle layer of the lower abdominal wall; we removed it. The second patient was a 56-year-old male who had received conservative treatment under the impression of his having diverticulitis in the sigmoid colon. An explorative laparotomy revealed a toothpick piercing the sigmoid colon; we performed an anterior resection. Both patients were discharged without postoperative complications.

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

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.

The effectiveness of maintenance care by non-surgical treatment on the periodontal disease in the people affected by leposy / 나학회지

BACKGROUND & OBJECTIVE: The purpose of this study is to prove the effectiveness of professional maintenance care to the periodontal disease by non-surgical approach with the toothpick method to improve the periodontal health. METHODS: The patients of this study were composed of 46 patients( 18 men and 28 women), suffering from chronic adult periodontitis, who had visited the department of dental clinic center. All of the subjects were over 50years old and be treated just by non-surgical method. Professional maintenance care using the toothpick method was performed every 3 months, and evaluations were also done after 1, 2, and 3 year-professional maintenance care based on the indices such as plaque index(O' Leary index), periodontal probing pocket depth, bleeding on probing, tooth mobility, the number of tooth loss, and the rate of tooth loss representing the state of periodontal health. RESULTS: 1. The longer the maintenance care, the more the effectiveness of controlling plaque. The rate of decrease in the dental plaque index was 1.5%, 4.2%, and 6.5% in 1, 2, and 3 year maintenance groups respectively(P>0.05). 2. The periodontal pocket depth decreased depends on the severity of periodontal pocket depth in all groups the maintenance years(P0.05). 4. Tooth mobility has decreased in the maintenance years, but did not show any difference statistically(P>0.05). 5. The number and the rate of tooth loss among the patients of 1year-maintenance group was 0.38, 1.44% respectively and that of 3 year-maintenance group was 0.44, 1.73% each. CONCLUSION: The results of this study mentioned above suggest that professional maintenance care should be operated effectively to prevent and to maintain the periodontal disease systematically on the purpose of proving the quality of life, and that it could be applied to the medical insurance system in other to try to make the most of the adult oral health care positively.

A Case of Liver Abscess Associated with Duodenal Perforation by a Toothpick / 대한소화기내시경학회지

The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature.

A Case of Liver Abscess Caused by Toothpick Penetrating Gastric Wall / 대한소화기내시경학회지

The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare.

Colon Perforation by an Ingested Toothpick

Foreign bodies in the gastrointestinal (GI) tract can be seen in all age groups and is not uncommon to see in the emergency department. Most are pediatric, edentulous, incarcerated and/or psychiatric patients. Since ingested objects are expected to pass spontaneously in 80% to 90% of patients with normal anatomy, direct foreign body removal using surgical intervention is rarely required. However, an ingested toothpick is of surgical interest as a cause of significant morbidity and even mortality. This is due to the difficulty in preoperative diagnosis resulting from a lack of history of ingestion of the toothpick and to the toothpick's radiolucent qualities. We report the case of a patient with peritonitis due to perforation of the sigmoid colon, a complication of accidental ingestion of a toothpick, that was diagnosed at the surgical field. Related literature is reviewed together.

Two Cases of Needle and Toothpick Stuck in the Stomach / 대한소화기내시경학회지

Foreign bodies in the stomach are usually ingested by children under 5 years of age, persons with dentures, alcoholics, mentally disturbed individuals or prisoners with a purpose of secondary gain. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metals, fish bones and etc. A needle or a toothpick in the stomach has been rarely reported in an adult.. We present two cases of patients: one case of patient with needle stuck in the stomach, who swallowed for the purpose of secondary gain, and the other case of patient with toothpick stuck in the stomach, who did not realize having swallowed it. A 23-year-old man, prisoner, was admitted to hospital due to epigastric pain after ingestion of a needle. Endoscopy showed a black needle, 1.2cm long stuck at the prepyloric antrum. It was removed by the endoscopic biopsy forceps through the overtube used in endoscopic variceal ligation and proved to be a needle with a length of 4.9 cm and a diameter of 0.1 cm. A 58-year-old woman developed an acute onset of hematemesis and epigastralgia, and presented to the emergency room. On admission, her blood pressure was 60/40 mmHg. An emergency endoscopy showed a yellowish, thin, stiff material 3.5cm long stuck at the greater curvature of the antrum with meat materials. It was removed by the above method and proved to an wooden tooth pick with a length of 6.5 cm and a diameter of 0.2 cm. No active bleeding was noted from the removed site. She did not realized she had swallowed the toothpick. She was discharged without complication.

A Case of Toothpick Stuck in the Stomach / 대한소화기내시경학회지

Foreign bodies in the stomach are usually ingested by children under the age of 5 years, persons with dentures and alcoholics or mentally disturbed individuals. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metal, fish bones and etc. A toothpick in the stomach has been rarely reported in an alert adult. Here, we present a case of a patient with toothpick stuck in the stomach, that she did not realize she had swallowed. It was removed by an endoscopy without any complications. A 57 year-old woman was admitted to Uijoagbu St. Mary's hospital because of epigastric pain for 10 days. The pain persisted constantly in the epigastrium and aggravated after meals. Sbe had an episode of vomiting during these days. A yellowish white, thin, stiff material 1.5 cm long was found by an endoscopic examination stuck at the less curvature of the antrum. It was removed by the endoscopic biopsy forceps and was proved to be an wooden toothpick, sharp at both ends, with a length of 6.6cm and a diameter of 0.2 cm. There was a small ulcer at the site of the removed toothpick and mild bleeding from the ulcer. The epigastric pain was relieved after the removal of the toothpick. She did not realize she had swallowed the toothpick. Four days later, a follow-up endoscopic examination revealed closed ulcer and no bleeding. She was discharged without complications.