Awadallah M, Ton L, Thoguluva Chandrasekar V, Yap JEL, Vega KJ. Ascending colon toothpick impaction identified during screening colonoscopy: A case report. World J Clin Cases 2026; 14(19): 121345 [DOI: 10.12998/wjcc.121345]
Corresponding Author of This Article
Kenneth J Vega, FACG, FACP, MD, Chief, Professor, Division of Gastroenterology and Hepatology, Prisma Health - Midlands, Division of Gastroenterology & Hepatology and The University of South Carolina School of Medicine Columbia, 3 Medical Park Drive, Suite 120, Columbia, SC 29203, United States. kenneth.vega@prismahealth.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 6, 2026; 14(19): 121345 Published online Jul 6, 2026. doi: 10.12998/wjcc.121345
Ascending colon toothpick impaction identified during screening colonoscopy: A case report
Mina Awadallah, Loc Ton, Viveksandeep Thoguluva Chandrasekar, John Erikson L Yap, Kenneth J Vega
Mina Awadallah, Division of Gastroenterology, University of Utah Health, Salt Lake City, UT 84132, United States
Loc Ton, Division of Gastroenterology, Kaiser Permanente, Sacremento, CA 95825, United States
Viveksandeep Thoguluva Chandrasekar, Division of Gastroenterology & Hepatology, Augusta University, Augusta, GA 30912, United States
John Erikson L Yap, University of Utah School of Medicine, University of Utah School of Medicine, Salt Lake City 84132, Utah, United States
Kenneth J Vega, Division of Gastroenterology and Hepatology, Prisma Health - Midlands, Division of Gastroenterology & Hepatology and The University of South Carolina School of Medicine Columbia, Columbia, SC 29203, United States
Author contributions: Awadallah M designed the study and wrote the manuscript; Ton L and Thoguluva Chandrasekar V contributed to data collection; Yap JEL and Vega KJ supervised the study and critically revised the manuscript; and all authors approved the final version
AI contribution statement: There was no AI tool used for preparation of clinical data, interpretation of results, or formulation of conclusions.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Kenneth J Vega, FACG, FACP, MD, Chief, Professor, Division of Gastroenterology and Hepatology, Prisma Health - Midlands, Division of Gastroenterology & Hepatology and The University of South Carolina School of Medicine Columbia, 3 Medical Park Drive, Suite 120, Columbia, SC 29203, United States. kenneth.vega@prismahealth.org
Received: March 26, 2026 Revised: May 12, 2026 Accepted: June 4, 2026 Published online: July 6, 2026 Processing time: 102 Days and 11.1 Hours
Abstract
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.
Core Tip: Wooden toothpicks are radiolucent and may be missed on imaging, leading to delayed diagnosis. This case demonstrates ascending colon toothpick impaction discovered during screening colonoscopy after a prior episode of acute abdominal pain with computed tomography suggestive of obstruction. Endoscopic removal was successful without complication, emphasizing the importance of clinical suspicion and timely endoscopic evaluation.
