SONOGRAPHIC DETECTION OF CLINICALLY UNSUSPECTED SWALLOWED TOOTHPICKS AND THEIR GASTROINTESTINAL COMPLICATIONS

We retrospectively analyzed the clinical presentation and imaging inve stigation in 4 cases of surgically (2 cases) or endoscopically (2 case s) proven toothpick-related gastrointestinal perforation. The toothpic k perforated the stomach (2 cases), the sigmoid (1 case), and the ileu m (1 case). Sonographic appearance of the toothpick was a linear, hype rechoic (3 cases) or hypoechoic (1 case) image of variable length (mea n: 2.5 cm) with inconsistent posterior shadowing in the longitudinal a xis. In transverse section a hyperechoic dot (4 cases) with clear, thi n, sharp, posterior shadowing (3 cases) was seen. Following sonography (4 cases), CT scan (2 cases), and upper GI study (2 cases), the preop erative diagnosis of GI perforation by foreign body compatible with to othpick 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. (C) 1994 John Wiley and Sons, I nc.