A Rare Case of a Gastrointestinal Foreign Body of Unusual Localization

Background: Foreign body (FB) and food impaction are some of the most common gastrointestinal complaints seen in the emergency department. Case Report: A 30-year-old man presented to the clinic with epigastric pain. His wife suspected that he may have inadvertently swallowed a wooden toothpick, which had been left in a glass of soda he drank yesterday. Fibrogastroduodenoscopy was done, but no FB was seen. The patient was kept in the clinic for observation for 24 hours. A week later, due to pain of the same type, he was rehospitalized in the same clinic. The patient was diagnosed with intercostal neuralgia, prescribed appropriate medication, and discharged from the hospital. Three months later, the patient developed a fever with chills, pain in the epigastric region and diarrhea. He was hospitalized again in the same clinic. Based on laboratory and abdominal CT findings, acute pancreatitis was diagnosed. He was discharged from the clinic in a few days. Later an MRI examination was performed. The diagnosis was the same. Since the patient’s condition remained critical, he decided to apply to the First University Clinic on his own. A detailed anamnesis was collected. Previous imaging studies were analyzed in detail. Attention was drawn to the presence of a completely insignificant white spot in the parapancreatic tissue, which, after converting the image from the axial to the sagittal section, took on a toothpick-like appearance. The endoscopic examination revealed that the toothpick had completely passed out of the lumen. Open surgery was performed. Two years have passed since the operation. The patient is practically healthy. Conclusion: Our case of complication and location of a FB is rare, which makes it difficult from both diagnostic and therapeutic points of view. Our experience once again shows how important the interaction of a multidisciplinary team is, as well as the correct sequence of examinations and detailed analysis of data.