Teenage Athlete’s Mystery Illness Had Doctors Stumped – Until They Found A Toothpick

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Turns out a little toothpick can pack quite the gut punch. An 18-year-old athlete nearly lost his life to the wood pick when he swallowed it while chowing down on a sandwich, according to The New England Journal of Medicine.

The medical rarity is quite the saga, with three hospitals in different parts of the country having trouble establishing a diagnosis, even with the use of sophisticated imaging.

The agonizing pilgrimage of the toothpick in his body started 20 days prior to his first hospital visit, when he developed fevers and pain in the lower right region of his abdomen during a trip to the southeastern United States for athletic training. He later visited a hospital due to fevers, abdominal pain, and blood in his stool. After five hours of observation, however, he was discharged. During the next two weeks, no symptoms but mild nausea persisted.

This is when the young man’s situation got much, much worse. He visited another hospital with similar symptoms in addition to lower back pain. Magnetic resonance imaging (MRI) of the abdomen and pelvis revealed mildly distended, fluid-filled loops of his small bowel and air-fluid in the rectum. The doctors gave him intravenous fluids and medicine, and encouraged the young man to return to New England for further evaluation.

At the Massachusetts General Hospital in Boston, blood and stool samples were obtained for culture, they examined him for parasites, performed tests for various antigens, and tested for viral and bacterial illnesses. All were negative.

A toothpick perforated the sigmoid colon and an associated arterioenteric fistula (inset). The New England Journal of Medicine ©2019

They then performed a CT scan of the abdomen and pelvis. No abnormalities were detected. His temperature was now hovering near 40°C (104°F) with associated rigors and mental confusion. The next day his fever spiked to 40.6°C (105°F).

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