# Gastric Perforation With Hepatic Involvement due to an Ingested Wooden Toothpick: A Case Report

## TL;DR

A 52-year-old man had a wooden toothpick perforate his stomach and liver, highlighting the need for prompt diagnosis and surgery in unexplained abdominal pain cases.

## Contribution

This case report presents a rare instance of hepatic involvement from a gastric perforation caused by a wooden toothpick.

## Key findings

- A wooden toothpick was found perforating the stomach and liver in a patient with unexplained epigastric pain.
- CT imaging failed to detect the foreign body, but exploratory surgery confirmed the perforation and enabled successful repair.
- The case emphasizes the importance of clinical suspicion and timely surgical intervention in similar rare scenarios.

## Abstract

Toothpick ingestion is a rare but dangerous clinical event due to the risk of gastrointestinal perforation and migration into adjacent organs. Diagnosis is often delayed because patients rarely recall ingestion, and wooden toothpicks are radiolucent. We present a case of a 52-year-old man with epigastric pain and no clear etiology. CT imaging showed free air near the gastric body but did not reveal the foreign body. Exploratory laparotomy identified a wooden toothpick perforating the anterior gastric wall and segment II of the liver. Surgical repair was performed successfully, and the patient had a full recovery without complications. This case highlights the importance of clinical suspicion in patients with unexplained abdominal pain, particularly those with risk factors like alcohol use. Prompt surgical intervention is essential when imaging is inconclusive. Awareness of such rare presentations can help reduce diagnostic delays and improve patient outcomes.