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February 4, 2019

An 18-year-old was on the verge of death. The culprit? A toothpick.

Daily Briefing

    Over the course of three weeks, an 18-year-old professional athlete suffered from severe symptoms and nearly died—all thanks to a toothpick he didn't know he'd swallowed, according to a report published in the New England Journal of Medicine, Denise Grady reports for the New York Times.

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    A bewildering set of symptoms, with no clear cause

    The man, whose identity was kept confidential by his doctors, first presented at an ED with fever and pain in the lower right of his abdomen, as well as nausea and diarrhea, Grady writes. Doctors performed blood tests and a CT scan, but all the results were normal.

    Over the next two weeks, the man's pain improved, though he still had some mild nausea. But then, during a trip to a different city, his pain came back, his bowel movements began containing blood, and his temperature spiked to more than 103 degrees Fahrenheit, Grady writes.

    He went to another ED, where doctors ordered an MRI along with the usual blood tests—but once again, doctors couldn't identify the problem. The man was given intravenous fluids and medicine for his fever and went back home to New England.

    Two days later, the man saw his team's doctor at Massachusetts General Hospital (MGH), who ordered further tests for the following day. But by the following morning, the man's symptoms had taken a turn for the worse—a fever, more blood in his stool, and worse pain, Grady writes.

    At one point, his fever spiked at 105 degrees.

    The culprit is revealed

    Finally, the man received a colonoscopy. According to Fabian Scheid, a doctor on the medical team, doctors were expecting to see an unusual inflammatory disease—but instead, they found a toothpick. It had poked through his intestinal wall and pierced an artery, creating a path for bacteria to enter his bloodstream.

    Upon questioning, the man remembered that he'd eaten a sandwich a few weeks earlier, shortly before his symptoms began. Presumably, that was when he swallowed the toothpick.

    Cases of toothpicks causing serious injuries are rare, Grady writes, but they've been reported before. Because toothpicks aren't affected by stomach acid or digestive enzymes, they can pass largely intact into the intestines and wreak havoc on the body. An analysis of 136 cases of injuries from toothpick ingestion that were reported in medical journals found that almost 10% were fatal, Grady reports.

    In the Massachusetts' man's case, his injuries very nearly became life-threatening. When doctors removed the toothpick, blood began shooting from an artery.

    He was rushed to an OR, where doctors repaired his intestine and replaced a 1.2 inch segment of the artery with a vein removed from his thigh. Doctors also had to make a series of large incisions into his calf to relieve swelling in his legs.

    After a week in the hospital, the man was able to leave and walk without help. He spent months in physical therapy and, over time was able to regain his athletic abilities, Grady writes. Seven months after his illness, he was able to play in his first professional game.

    And while Scheid emphasized that the man's case was rare, he also admitted he'd gained respect for the dangers of toothpicks. "I stay away from them," Scheid said. "I don't offer them to any guests at my barbecue parties" (Grady, New York Times, 1/30).

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