Ascending colon toothpick impaction identified during screening colonoscopy: A case report

BACKGROUND Toothpick ingestion is uncommon but potentially dangerous due to their sharp pointed ends and, for wooden toothpicks, their radiolucent nature, which evades imaging detection. Delayed diagnosis may lead to localized infection, obstruction, or perforation. This case highlights diagnostic limitations and successful endoscopic management of an ascending colon embedded wooden toothpick. CASE SUMMARY A 53-year-old man with hypertension, diabetes mellitus, hyperlipidemia, and obesity underwent initial screening colonoscopy. Of note, he presented 3 weeks prior to the emergency department with acute abdominal pain and leukocytosis. Contrast-enhanced computed tomography demonstrated small bowel obstruction with a suspected right mid abdomen transition point but no perforation. Symptoms resolved with supportive care. During colonoscopy, a wooden toothpick was found embedded in the ascending colon with purulent discharge. The toothpick was removed using a snare, and a hemoclip was deployed. Post-procedure imaging showed no perforation, and he recalled potentially swallowing a toothpick the day prior to his emergency department visit. The patient remained asymptomatic at 2-week follow-up. This case is notable for incidental discovery during screening colonoscopy following a prior negative computed tomography (CT) evaluation. CONCLUSION Sharp foreign bodies, such as toothpicks, can cause localized inflammation, perforation, or abscess formation if lodged within the gastrointestinal tract. The ascending colon is a rare site for that, and diagnosis is often delayed due to nonspecific symptoms along with object imaging radiolucency. In this case, the toothpick may have been associated with his prior abdominal symptoms, though undetected on CT. This highlights limitations in identifying ingested sharp objects as well as the importance of clinical suspicion in patients with unexplained abdominal symptoms. Endoscopic removal, when feasible, is effective and safe.