![]() ![]() Differently, pancreatic migration of swallowed toothpick is much less common. Surgical treatment for such disorder is mandatory. ![]() Usually, the object is metallic and sharp, but there are more than 15 case reports of toothpick migration to the liver leading to hepatic abscesses. Some reports describe hepatic abscesses caused by FBs. Perforations caused by swallowed foreign bodies at the duodenum are particularly interesting once it may not cause peritonitis but migration to adjacent organs such as pancreas, liver, and retroperitoneum. After all steps, stable patients should be admitted for observation if location is not possible. If patient is stable and the toothpick is found in colon, it should be removed by colonoscopy. ![]() If ultrasound does not provide a definitive diagnosis, the next step should be determined by patient's clinical condition: if stable and oligosymptomatic, a conventional X-ray to exclude free gas if unstable or signs of peritonitis, contrast-enhanced CT scan is the next step followed by urgent surgical removal. Abdominal ultrasound should be the next step if gastroscopy do not detect the object or if the time interval after ingestion is longer than 24 hours. The most sensible exam for diagnosis is flexible endoscopy that presents no reported mortality when the toothpick is successfully extracted, and therefore is the first diagnostic step. Based on the review, an algorithm for the management of toothpick ingestion was developed by Steinbach et al. More than half of all cases go unnoticed by patients (54%) and lead to perforations in almost 80% of all cases. Regarding specific ingestion of toothpicks, a recent literature review analyzed 136 reported cases from 1927 to 2012. On the contrary, toothpick ingestion poses the greatest risk of perforation. However, if the object reaches the stomach, asymptomatic patients can be safely observed for development of symptoms as more than 80% pass spontaneously. Endoscopic procedure should be preceded by adequate radiological workup which allows the correct therapeutic planning (sided view versus front view e.g., need of endoscopic ultrasound or fluoroscopy). It presents a success rate of around 99% and extremely low morbidity. With regard to therapeutic strategy, flexible endoscopy is the gold-standard method for noncomplicated cases. ![]() The incidence of FB ingestion requiring surgery varies from less than 1% to 14%. The major risk factors for perforation are ingestion of sharp or pointed FBs, length of stay in the digestive tract longer than 24 hours and previous gut malformation or abdominal surgery. However, there are several complications and one of the most severe is perforation. The size, shape, or multiplicity is not useful to predict if a FB would pass. įB ingestion has extremely low morbidity and mortality rates, especially after the object reaches the stomach. Also, the sort of object swallowed depends on the age and cognitive status of the patient: infants usually take small and easy-to-get objects, and adults swallow bones and other food related items, while the elderly and neurologically impaired patients usually swallow dentures. Among the elderly, it is mainly linked to improper use of dental prosthesis. Regarding adults, it is related to psychiatric disorders, alcoholism, neurodevelopmental delay, and intentional swallowing for smuggling purposes. The pediatric population is the major victim of foreign body (FB) ingestion, especially patients between 6 months and the age of 6. ![]()
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