P1594 - Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer

Pranav Chalasani, MD¹, Katia El-Jurdi, MD², Kha Ngo, MD^2
1Wayne State University School of Medicine / Ascension Providence Rochester Hospital, Rochester, MI; ²Ascension Providence Hospital, Southfield, MI

Introduction: Foreign body ingestion, particularly of sharp objects like toothpicks, is a rare cause of gastrointestinal complications in adults. These complications can include duodenitis, ulcers, or perforation, and they often present with nonspecific symptoms. We report a case of duodenal ulcer secondary to toothpick ingestion in an elderly patient, who initially presented with abdominal pain of unclear origin.

Case Description/Methods: An 82-year-old male with a history of hypertension, type II diabetes, and dyslipidemia presented to the emergency department with abdominal pain lasting for two weeks. The pain initially started in the right upper quadrant and radiated to the right lower quadrant, describing it as dull achy pain with no aggravating and relieving factors. He denied any melena, hematochezia, hematemesis, or changes in bowel habits prior to this episode. Physical exam was unremarkable, with negative Murphy’s sign. Normal bowel sounds were heard throughout the abdomen without signs of peritonitis. Laboratory work up revealed low hemoglobin 8.6mg/dl and rest of results were within normal limits, including normal liver function tests. A Computer Tomography(CT) scan without contrast revealed duodenitis and no definite extraluminal air was observed. An esophagogastroduodenoscopy (EGD) showed mild localized inflammation in the gastric body and antrum. In the second portion of the duodenum, a toothpick was found and successfully removed using forceps. Multiple superficial duodenal ulcers were also identified, the largest measuring 5 mm in diameter. Patient’s abdominal pain subsided and was advised to continue using proton pump inhibitor (PPI). He was discharged without any complications.

Discussion: This case underscores the importance of considering foreign body ingestion in the differential diagnosis of abdominal pain in elderly patients. According to literature and a few past case reports, ingested toothpicks can appear as hyperdense objects on CT scan. However, it was challenging to determine whether there was a foreign body or another type of ingested material on this patient’s imaging findings. Clinicians should consider foreign body ingestion as a possible cause of gastrointestinal symptoms, especially in patients with atypical presentations. A multidisciplinary approach involving radiology, surgery, and gastroenterology can aid in the accurate diagnosis and appropriate management of such cases.


Disclosures:


Pranav Chalasani, MD¹, Katia El-Jurdi, MD², Kha Ngo, MD². P1594 - Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.