Swallowing a sharp item like a toothpick introduces a significant danger. Unlike many small, smooth foreign bodies that pass harmlessly, a toothpick is a rigid, pointed object that does not soften in the digestive tract. This combination of sharpness and material, typically wood or bamboo, makes it exceptionally high-risk for causing serious internal injury. Furthermore, the low density of wood prevents it from showing up clearly on standard X-rays, complicating diagnosis.
The Toothpick’s Path Through the Digestive System
Once swallowed, the toothpick travels through the gastrointestinal tract via muscular contractions called peristalsis. The sharp edges pose a threat, particularly where the digestive tube naturally narrows or bends sharply. While many ingested objects pass without incident, a high percentage of swallowed toothpicks cause problems. The esophagus and stomach are initial sites where the object may lodge, but the most vulnerable areas are the acute angles of the intestines, such as the duodenum, cecum, and rectosigmoid junction. Perforation is most likely to occur in the small or large intestine.
Signs of Internal Injury or Obstruction
The most alarming aspect is the high probability of perforation, which occurs in up to 79% of reported cases and introduces a serious risk of infection. Symptoms from a lodged or perforated toothpick are often non-specific, delaying diagnosis for days or even months. Older adults, especially those wearing dentures, may not recall swallowing the object, complicating the diagnostic process.
Persistent or worsening abdominal pain is the most frequently reported symptom, affecting over 80% of patients with complications. The location of this pain can provide a clue to the injury site, sometimes mimicking appendicitis in the lower right abdomen. Other urgent warning signs include fever and chills, which indicate a spreading infection or abscess formation.
Difficulty swallowing (dysphagia) coupled with chest pain suggests the toothpick is lodged in the esophagus. Signs of gastrointestinal bleeding, such as black, tarry stools (melena) or bright red blood (hematochezia), signal damage to the digestive lining. The development of peritonitis, a life-threatening inflammation of the abdominal lining, is marked by severe abdominal tenderness, rigid abdominal muscles, and signs of sepsis.
Immediate Steps and Medical Intervention
If a toothpick is swallowed, immediately seek emergency medical attention, even if no symptoms are present. Patients must not attempt to induce vomiting, as this risks tearing the esophagus or lodging the object in the airway. Refrain from eating or drinking anything until a medical professional has assessed the situation.
Diagnosis begins with a detailed history, but imaging is necessary for confirmation. Standard X-rays often cannot visualize wood or plastic toothpicks because they are radiolucent. The preferred initial diagnostic tool is a computed tomography (CT) scan, which is superior for detecting the foreign body and identifying complications like abscesses or free air signaling perforation.
If the toothpick is located in the upper digestive tract, retrieval is typically performed via an upper endoscopy, using a flexible tube with a camera passed down the throat. A colonoscopy is used if the object has traveled into the lower bowel. If the toothpick has caused a perforation, an abscess, or migrated outside the bowel wall, surgical intervention, such as a laparotomy, is required to remove the object and repair the damage.