Toothpicks seem so innocent. Whether staking down juicy sliders on game day or harpooning fruits bobbing in happy-hour cocktails, the mini skewers often spike our festive occasions. But, make no mistake, they have a vicious side. Given the chance, they will mess you up.

Of the poor souls who somehow ingest one of the wee daggers, 79 percent will end up with stab wounds their innards. Ten percent will die from their toothpick-inflicted injuries.

A new case study in the New England Journal of Medicine lays out some of the gory details behind those stats. A team of Boston doctors tell the woebegone tale of an unnamed, 18-year-old professional athlete who unknowingly swallowed a wooden toothpick. After weeks of abdominal pain, multiple visits to emergency rooms, bloody poops, and a life-threatening infection, doctors finally discovered it—lodged in his colon, piercing through his intestinal wall and into a neighboring, large artery. Then there was the harrowing effort to remove it and patch him up.

The saga began while the fellow was traveling in the southeastern US for athletic training. He was suddenly struck by a bout of diarrhea, nausea, fever, and pain in the lower right part of his abdomen. So he went to an emergency department to get checked out. But after scans and blood tests, the doctors were stumped and discharged him after five hours without a specific diagnosis.

For the next two weeks, he felt a bit better; the pain and fevers subsided. But then on another training trip—this time to the West—the pain returned, with bloody stools and a fever above 103 degrees Fahrenheit. Back in an emergency department, doctors ordered an MRI but again couldn’t figure out what was causing his symptoms. The team’s internist encouraged him to return home to New England for further medical evaluation.

Back home a few days later, the internist saw him at an outpatient clinic and arranged for him to have a colonoscopy to try to find the source of the trouble. But the next morning, the unlucky chap called the doctor saying that he had taken the bowel-preparation regimen for the procedure and had a bowel movement with a “large volume of blood.” He was also suffering from chills, fever, and intense pain. The internist told him to head to the emergency department at Massachusetts General Hospital immediately.

Once there, his condition worsened, and he was admitted. Tests found bacteria in his bloodstream. His fever spiked to 105 degrees, he appeared confused, his heart raced, and he was breathing rapidly—all indicating sepsis, a life-threatening immune response to a bacterial infection.

At that point, doctors went ahead with the colonoscopy and finally found the toothpick piercing his colon. But, when they plucked it out, he began bleeding profusely. The doctors tried to pinch off the bleeding by placing nine clips in his intestines, but that didn’t work. They rushed him into surgery to stem the life-threatening bleeding and found that the toothpick had also slashed an artery—and it was in bad shape. They ended up cutting out a 3cm chunk of the artery and replaced it with tissue harvested from a vein in his leg. In doing that, they had to make slices in his leg to relieve pressure from the loss of circulation (aka a four-compartment fasciotomy).

About a week later, our forlorn protagonist was released from the hospital. He could walk on his own at that point, but he needed seven months of rehabilitation and training before he could play in another professional game. The doctors reported that, since his recovery, he “continues to have a substantial role in his sport.”

In an interview with The New York Times, one of his doctors reported that after the man was told that a toothpick was the culprit, he recalled that, shortly before he fell ill, he ate a sandwich that didn’t go down quite right.

NEJM, 2018. DOI: 10.1056/NEJMcpc1810391  (About DOIs).

https://arstechnica.com/?p=1450193