An 18-year-old professional athlete nearly died after swallowing a toothpick, which it took his doctors three weeks and four hospitals to diagnose. The grisly case study might seem like it took way too long for doctors to figure out, but as the young man’s physicians at Massachusetts General Hospital write in the New England Journal of Medicine, wooden toothpicks are remarkably difficult to detect.
The young man, whose identity was kept confidential, was one of the lucky ones. Since wooden toothpicks are also hard to digest, 10 percent of cases in which a patient swallows a toothpick end up being fatal.
The athlete’s abdominal pain and fevers began 20 days before he was admitted to Massachusetts General Hospital during an athletic training trip. He’d first gone to a local hospital in the southeastern United States, but the doctors there took a CT scan, kept him for five hours for observation, and sent him on his way without a diagnosis. His case didn’t seem serious yet, despite him having diarrhea and nausea in addition to the pain and fever. For a while, things seemed to be getting better.
“During the next 2 weeks, the abdominal pain diminished and the fevers and loose stools resolved; mild nausea persisted,” the authors of the case study write. “The patient traveled with his team to the western United States and participated in reduced-intensity athletic training.”
But then, four days before he ended up at Massachusetts General, his abdominal pain came back, this time accompanied by lower back pain. When he developed a 103-degree fever, too, he went to a second hospital. Doctors knew something was wrong, but couldn’t figure out what. They encouraged him to return to New England to seek more involved care.
Then, one day before he finally ended up in surgery, he saw an outpatient doctor at Massachusetts General, whom he told about a fever, bloody feces, and abdominal and back pain. Things were getting worse. They scheduled a colonoscopy for the next day to get to the bottom of things.
Finally, a CT scan revealed fresh blood in the colon but offered doctors little in the way of clues to what might be causing the bleeding. When the doctors finally performed a colonoscopy, they were stunned to see a toothpick. As the literature suggested, it just didn’t show up in either of the CT scans. The patient was rushed into surgery, where doctors used nine hemostatic clips to stop the bleeding that started as soon as they pulled it out.
Several operations later, the young man awoke in intensive care to learn what had happened. After doctors told him what happened, The New York Times reports, he recalled eating “a sandwich that did not go down so well.”
The young athlete was finally discharged on his tenth day in the hospital, six days after he’d undergone a second surgery.
Seven months after his injury, he played in his first professional game, write his doctors, “and he continues to have a substantial role in his sport.”