Abdominal ultrasound showed a 5cm hyperechoic lesion inside the gallbladder (GB), with penetration of swelling GB wall. Foreign body penetration related chronic cholecystitis was impressed.
The computer tomography revealed a hyperintense foreign body penetrating through gallbladder wall with GB wall thickening (Figure 2). There was no abscess or focal fluid accumulation. Then, laparoscopic cholecystectomy was performed, and a 5cm toothpick penetrated the gallbladder was found (Figure 2). But he cannot recall any history of toothpick injection before. After the surgery, the post-operative course was uneventful and the abdominal pain also resolved.
This case is the first to report the toothpick penetrated the GI tract to the GB, resulted in cholecystitis. In literature review, we found two studies reported the characteristics, diagnosis and managements of toothpick ingestion [1, 2]. Briefly, most patients did not remember toothpick ingestion (88%). Intermittent abdominal pain (70%), fever (54%), hypotension (20%), and nausea are the frequent initial presentations. Spontaneous passage of a toothpick through GI tract is less likely. If left unawareness, the course will present as relapsing abdominal pain despite courses of antibiotics administration, and even mimic Crohn’s disease with fistulizations [3]. The Figure 3. demonstrated the most common sites and the frequency of toothpick injury in the GI tract [1]. The suggested management algorithm was shown in Figure 4. Most importantly, early endoscopic removal can prevent toothpick transition to the small bowel and penetration to other organs.
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