Successful endoscopic retrieval of a toothpick stuck in the small intestine using double-balloon enteroscopy
09 September 2019 (online)
A 59-year-old man was admitted to our hospital with nausea and vomiting. Laboratory test results demonstrated an elevated white blood cell count of 10 540/µL (normal range 3200 – 8000/µL) and his C-reactive protein (CRP) level was 2.82 mg/dL (normal < 0.30 mg/dL). He had a history of appendectomy for appendicitis and ventriculoperitoneal shunting for subarachnoid hemorrhage. Abdominal computed tomography (CT) showed a small-bowel obstruction (SBO) with dilatation, fluid collection, and caliber change in the proximal part of the small intestine ([Fig. 1 a]). Ascites, abscesses, and free air were not observed; however, a high-density needle-shaped structure was noted incidentally inside the proximal part of the small intestine with minimal surrounding inflammation ([Fig. 1 b]).
A transnasal ileal tube was placed to decompress the SBO; after 4 days, the SBO had improved, so the tube was removed. In order to remove the foreign body from the small intestine, we performed double-balloon enteroscopy (DBE) via the oral route ([Fig. 2 a]). DBE revealed a wooden toothpick that was stuck in the proximal part of the small intestine ([Fig. 2 b]), and we successfully removed the toothpick using grasping forceps without any complications ([Fig. 3]; [Video 1]). A follow-up CT scan immediately after the DBE revealed no free air surrounding the small intestine.
Video 1 Endoscopic retrieval of a toothpick stuck in the small intestine using double-balloon enteroscopy via the oral route and grasping forceps.
The patient had no memory of ingesting the toothpick. His clinical course was uneventful, and he was discharged 9 days after the DBE.
According to previous reports, toothpick perforation of the duodenum can be treated with endoscopic removal   . However, toothpick perforation of the small intestine, which often exists with other complications, such as abscess formation, has previously been treated by laparotomy  . To the best of our knowledge, this is the first English case report of the successful endoscopic removal of a toothpick stuck in the small intestine using DBE. We suggest that DBE may offer a nonsurgical alternative for the removal of a toothpick stuck in the small intestine.
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