title: Toothpick inside the Common Bile Duct: A Case Report and Literature Review.
abstract: The incidence and prevalence of foreign body (FB) ingestion are difficult to estimate. Unlike other foreign bodies, the ingestion of a toothpick is very uncommon and carries high morbidity and mortality rates. We report a case of a 73-year-old female patient presenting mid-term epigastric pain. Abdominal ultrasound revealed a slightly dilated common bile duct (CBD) and magnetic resonance showed an irregular filling failure in distal CBD and gallstones. Endoscopic Retrograde Cholangiopancreatography revealed major papilla on the edge of a diverticulum and confirmed the distal filling failure. After sphincterotomy, a partially intact toothpick was extracted from the CBD. Neither fistulas nor perforation signs were found. Literature related to foreign bodies and toothpick ingestion was reviewed and some hypotheses to explain the reported case were created. To our knowledge, this is the first report of a toothpick lodged inside the biliary tract.
authors.affiliation: Gastroenterology Department, Faculty of Medicine, University of São Paulo, 05403-001 São Paulo, SP, Brazil.
authors.forename: V O
authors.identifier: 0000-0003-3315-8640
authors.initials: VO
authors.lastname: Brunaldi
authors.affiliation: Pathology Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: M O
authors.initials: MO
authors.lastname: Brunaldi
authors.affiliation: Division of Digestive Endoscopy and General Surgery, Carlos Fernando Malzoni Hospital, Matão, SP, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Masagao
authors.affiliation: Division of Digestive Endoscopy and General Surgery, Carlos Fernando Malzoni Hospital, Matão, SP, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Silva
authors.affiliation: Division of Digestive Endoscopy and General Surgery, Carlos Fernando Malzoni Hospital, Matão, SP, Brazil.
authors.forename: H
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Digestive Surgery Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: J E
authors.initials: JE
authors.lastname: Brunaldi