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

Deadly? bobbyfotoscape

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).

The team were stumped. Uncertain what was wrong with the young man, they performed a colonoscopy to see if that could clarify the conundrum. A large amount of fresh blood was found in the sigmoid colon, the region of the large intestine closest to the rectum and anus. They finally spotted the troublesome little agent: a 5-centimeter (2-inch) toothpick lodged 25 centimeters (nearly 10 inches) from the anal opening. 

You would think this is where the painful journey ends, but sadly it’s not. When the medical team removed the toothpick, blood spurted from his artery. They tried to fix the issue with nine hemostatic clips, but the bleeding continued. A 3-centimeter (1.2-inch) segment of artery was cut out and replaced with a vein from his thigh. They then performed four calf incisions to the fascia (connective tissue) to reduce pressure from swelling. 

Days later he woke up in the intensive care unit. Thankfully, the patient healed well after surgery and was discharged six days after the second surgery. He walked out of the hospital of his own accord and without assistance. Seven months later, he played in his first professional game. 

Moral of the story: No matter how hungry you are, double check there aren’t toothpicks hidden in your sandwich first. 

(B) A wooden toothpick was found 25 cm from the anal orifice. (D) The toothpick after removal. The New England Journal of Medicine ©2019

[H/T: The New York Times]

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