Sonographic detection of clinically unsuspected swallowed toothpicks and their gastrointestinal complications

We retrospectively analyzed the clinical presentation and imaging investigation in 4 cases of surgically (2 cases) or endoscopically (2 cases) proven toothpick-related gastrointestinal perforation. The toothpick perforated the stomach (2 cases), the sigmoid (1 case), and the ileum (1 case). Sonographic appearance of the toothpick was a linear, hyperechoic (3 cases) or hypoechoic (1 case) image of variable length (mean: 2.5 cm) with inconsistent posterior shadowing in the longitudinal axis. In transverse section a hyperechoic dot (4 cases) with clear, thin, sharp, posterior shadowing (3 cases) was seen. Following sonography (4 cases), CT scan (2 cases), and upper GI study (2 cases), the preoperative diagnosis of GI perforation by foreign body compatible with toothpick was made in all cases, although none of the patients was aware of having swallowed a toothpick. This information will be of help in making early sonographic diagnosis of toothpick-related GI perforation in patients with or without symptoms.