Toothpick perforation of the intestines.

Toothpicks have been used since antiquity as instruments for mouth cleansing and as eating utensils. Toothpick injury to the gastrointestinal tract is often suspected only at the time of operation because patients rarely relate a history of swallowing toothpicks and most toothpicks are not radiopaque. The spectrum of toothpick injury to the gastrointestinal tract is illustrated by 5 patients who developed toothpick perforation of the gastrointestinal tract. Two patients died as a result of complications of toothpick injury, one of these presenting with recurrent gram negative sepsis with multiple organisms due to a duodenal-inferior vena caval toothpick fistula. In two instances the toothpicks were removed at operation and one that was penetrating the duodenum was removed with a fiberoptic duodenoscope.