Two Toothpicks: A Trip Along the Gastrointestinal Tract

Abstract A 34-year-old male presented with a 2-day history of persistent abdominal pain six days after accidental toothpick ingestion. Abdominal computed tomography revealed a 42-mm linear high-density foreign body in the descending duodenum, associated with bowel wall thickening, perienteric inflammatory exudation, and suspected microperforation. Emergency upper gastrointestinal endoscopy identified an embedded wooden toothpick, which was completely removed with foreign body forceps. Titanium clips were applied to seal the ulcerative and bleeding mucosal defect due to probable microperforation. The patient recovered uneventfully with nil per os, acid suppression and antibiotic therapy, and was discharged on day 3. Five days later, the patient returned with anal distending pain and defecatory stabbing discomfort. Digital rectal examination palpated a toothpick-like foreign body that was not visualized by anoscopy. Colonoscopy confirmed a second toothpick embedded in the rectal submucosa approximately 5 cm above the anal verge with local ulceration, which was successfully extracted using biopsy forceps. The patient achieved full recovery after symptomatic treatment. This rare case presents sequential gastrointestinal impaction of two separate toothpicks at duodenal and rectal sites, highlighting the variable and delayed complications of ingested wooden foreign bodies.