Endoscopic Removal of a Toothpick Penetrating the Gastric Wall and Extending Into the Head of the Pancreas: A Case Report and Brief Literature Review

Ingested toothpicks can perforate the gastrointestinal tract and penetrate adjacent organs. Pancreatic involvement is rare, and its management varies between surgical and endoscopic interventions. We report the successful endoscopic removal of a toothpick that penetrated the gastric wall and extended into the head of the pancreas. A 59-year-old man presented with a 5-day history of fever and epigastric pain. Laboratory tests revealed inflammatory changes, with normal serum amylase and hemoglobin levels. Non-contrast computed tomography (CT) with multiplanar reconstruction (MPR) revealed a linear, slightly hyperattenuating foreign body measuring at least 5 cm, extending from the posterior wall of the lower body of the stomach to the head of the pancreas, with minimal free air, surrounding fat stranding, and no dilation of the main pancreatic duct. Contrast-enhanced CT revealed no major vascular involvement or active extravasation. Esophagogastroduodenoscopy was performed on hospital day 3 with surgical backup. A wooden foreign body protruding from the gastric mucosa was removed with biopsy forceps through an overtube under conscious sedation. The extracted object was a 6.5-cm wooden toothpick. The post-procedural course was uneventful. This case highlights the value of MPR and contrast-enhanced CT in defining a foreign body's trajectory and determining procedural feasibility. Endoscopic removal may be a safe and minimally invasive alternative to surgery in selected cases of pancreatic penetration.