Intra-abdominal abscess caused by toothpick injury.

We present the case of a 42-year-old female who presented to our emergency department (ED) complaining of epigastric pain for four days. She had been seen in the outpatient department and ED previously for evaluation, but continued to experience epigastric pain with fever. Emergency panendoscopy was performed and a toothpick was discovered impacted in the duodenal bulb. The gastroenterologist was unable to remove the toothpick endoscopically. Computed tomography of the abdomen revealed a long and straight hyperdense foreign body, and intra-abdominal abscess formation. An emergency laparotomy was performed. The patient recovered gradually and was discharged 11 days later. She could not remember when she swallowed the wooden toothpick, but guessed that it was while out drinking. There is an old wives' tale in Taiwan that putting a toothpick in the cup while drinking beer reduces the likelihood of abdominal distention from the carbonation of the beer.