Hospitalized in critical condition, doctors find the cause-a toothpick!

Within days, he was fighting for his life. A web of infections and organ problems baffled specialists-until one tiny, everyday object emerged as the unlikely culprit.

A Medical Mystery in a Busy Boston Hospital

The patient, a 36-year-old man living in Boston and originally from Central America, arrived at Massachusetts General Hospital after several weeks of steadily feeling worse. He looked far younger than most people who show up in multi-organ failure. Still, his body told a different story.

Doctors found abnormalities almost everywhere they looked. His lungs showed suspicious shadows. His liver looked inflamed and enlarged. His blood counts had dropped. His lymph nodes were swollen. Scans revealed a blood clot in a kidney vein. Nothing seemed to fit together neatly.

Multiple organs were failing at once, yet there was no obvious trigger: no major trauma, no known chronic disease, no recent surgery.

In modern emergency medicine, teams solve most diagnostic puzzles within hours. Here, each test added a new piece without revealing a clear picture. The staff launched a step-by-step investigation, moving from basic blood tests to advanced imaging in search of a single unifying cause.

From Mild Discomfort to Critical Illness in Two Weeks

To understand what went wrong, doctors retraced the story from the beginning. About two weeks before his final admission, the man developed dull pain in his lower abdomen and back. It felt annoying rather than alarming. He kept working construction and tried to push through it.

About nine days later, the pain worsened. Fever and body aches followed. He finally went to the emergency department, where IV fluids and pain medication eased his symptoms. With no clear red flags during that first visit, he was discharged after feeling better.

The relief didn’t last. Within days, the abdominal pain came back-worse than before. Nausea and vomiting started. He began coughing, then noticed shortness of breath while walking. His energy collapsed. By the time he returned to the hospital, his condition had spiraled.

On his second arrival, staff noted yellowing of his eyes, a fast heart rate, low blood pressure, and low oxygen levels. This time, no one considered sending him home. He was admitted for urgent evaluation and close monitoring.

Abnormal Tests Everywhere They Looked

Blood and urine tests painted a concerning picture. His platelet count was low, suggesting reduced bone marrow production. Liver enzymes were high. Markers of inflammation surged. The overall pattern suggested a serious infection stressing multiple organs.

A chest scan showed a pulmonary opacity-a dense area in the lung often linked to infection or inflammation. On its own, that could have been explained by pneumonia. But the abdominal CT raised many more questions.

Imaging showed an enlarged liver, thickened bile ducts, swollen lymph nodes, and a contracted gallbladder. A blood clot blocked the right renal vein. Radiologists also noticed an unusual bridge of soft tissue stretching between the duodenum (the first part of the small intestine) and the right kidney.

Something had physically connected his intestine to his kidney area, suggesting a slow-burning injury that had gone unnoticed.

Blood cultures then identified Streptococcus anginosus, a bacterium often involved in deep-seated abscesses inside the body. It can move through tissues, trigger severe infection, and form pockets of pus in organs such as the liver or brain.

The Role of Alcohol and Hidden Aspiration

As the picture developed, the team examined lifestyle risk factors. He reported heavy drinking: four to five beers each weeknight and up to twelve per day on weekends. That pattern can weaken the liver and dull protective reflexes, including swallowing and coughing.

One theory emerged: aspiration pneumonia. With heavy alcohol use, a person may inhale small amounts of food, liquid, or vomit into the lungs. Those particles can carry bacteria and spark infection deep in the airways. This fit the lung findings on imaging.

Alcohol also disrupts the immune system. It can make it harder for the body to contain bacteria leaking from the gut or from minor injuries. His drinking likely helped bacteria like Streptococcus anginosus turn a local problem into a body-wide threat.

The Missing Link: An Object No Scan Could See

One major puzzle remained: the soft-tissue bridge between the intestine and the kidney region. That finding strongly suggested a duodenal perforation that had slowly healed around something lodged in the tissue.

Gurpreet Dhaliwal, a master clinician from the University of California, San Francisco, who joined the case discussion, proposed a bold hypothesis: the patient may have swallowed a foreign object that pierced the gut wall and migrated outward-carrying infection with it.

To test the idea, doctors performed an endoscopy, guiding a camera through the mouth into the upper digestive tract. In the duodenum, they found the culprit: a wooden toothpick, stuck through the wall of the small intestine.

A tiny wooden stick-likely from a club sandwich or used between teeth-had speared his gut and turned a routine meal into a near-fatal emergency.

The toothpick hadn’t appeared on earlier imaging because wood often blends in with surrounding tissue on standard CT scans. Metal shows up clearly. Organic materials like wood or bamboo can be easy to miss.

How a Toothpick Can Trigger Life-Threatening Sepsis

Once the toothpick pierced the duodenum, it likely allowed gut bacteria to spill into the abdominal cavity and nearby tissues. Over days, the infection spread toward the kidney region, seeding infection and creating inflammatory connections between organs.

This chain reaction produced multiple effects at once:

• a deep internal infection involving the intestine and nearby structures
  
• bacteria entering the bloodstream, leading to sepsis
  
• strain on the liver as it tried to filter toxins
  
• inflammation in blood vessels, increasing the risk of a clot in the right renal vein
  
• widespread immune activation, lowering platelets and disrupting normal blood counts
  

Sepsis occurs when the immune response to infection becomes so intense that it damages the body’s own organs. Blood pressure drops, tissues receive less oxygen, and organs begin to fail. Without rapid antibiotics and supportive care, sepsis can be fatal within hours or days.

Why Toothpick Injuries Often Go Unnoticed

Doctors have reported toothpick ingestion for decades, yet it remains uncommon and difficult to diagnose. Many people don’t remember swallowing anything unusual. Toothpicks can be hidden in sandwiches, burgers, or appetizers. They can also slip into the mouth while a person talks, laughs, or drinks.

Feature	Toothpick ingestion
Typical memory of the event	Often none; patients rarely recall swallowing it
Imaging visibility	Poor on standard X-ray and CT if wooden
Common complications	Intestinal perforation, abscesses, internal bleeding, sepsis
Clinical presentation	Ranges from mild abdominal pain to multi-organ failure
Urgency of treatment	A medical emergency once identified

Once clinicians recognize a toothpick as the source of injury, they treat it as an emergency. The object must be removed, and infections treated aggressively. Delays can allow the wooden splinter to erode blood vessels, leak bacteria, and trigger catastrophic internal bleeding.

A Rare Case That Changes How Doctors Think

After the toothpick was removed and targeted antibiotics were started, the man gradually improved. His liver tests began to normalize. The fever dropped. Breathing became easier. The team strongly advised him to stop drinking alcohol, at least during recovery. He followed that advice, which helped his organs heal.

Cases like this often end up in medical journals because they reshape how clinicians think through complex symptoms. When a patient has multiple unexplained organ problems, doctors typically first consider common causes: viral infections, autoimmune disease, cancer, or blood disorders. A wooden splinter in the gut ranks very low on that list.

This story pushes medical teams to keep rare, mechanical causes in mind when biology alone does not explain the full picture.

The episode also highlights a broader principle in emergency medicine: no symptom should be viewed in isolation. Mild back pain, cough, jaundice, and low platelets might seem unrelated-yet here they all traced back to the same tiny object.

What This Means for Everyday Life and Emergency Care

For most people, toothpicks seem harmless. They sit on restaurant tables, hold snacks together, or help remove food caught between teeth. Still, clinicians have documented hundreds of injuries linked to toothpicks, from punctured intestines to damaged arteries.

A few simple habits can reduce risk:

• Remove toothpicks from sandwiches and appetizers before eating, especially in dim lighting or when distracted
  
• Avoid talking or laughing with a toothpick in your mouth
  
• Don’t use toothpicks while intoxicated or extremely tired, when reflexes slow
  
• Seek medical care if sudden, unexplained abdominal pain follows a meal involving skewers or toothpicks
  

For emergency departments, cases like this encourage broader questioning. Asking about eating habits, bar snacks, kebabs, and decorative sticks can uncover clues that imaging misses. When CT scans look unusual but show no clear foreign body, clinicians may need to consider materials that don’t show up well-like wood, plastic, or fish bones.

Beyond toothpicks, this story points to a larger issue: how small, easy-to-ignore details can combine with lifestyle factors like heavy drinking to produce serious illness. Alcohol didn’t put the toothpick in this patient’s duodenum, but it likely made the consequences far worse by weakening his lungs, liver, and immune defenses.

For readers, the case offers a quiet reminder to take warning signs seriously. An unusual combination of symptoms-such as abdominal pain plus new breathing difficulty and yellowing of the eyes-deserves urgent attention, even in young adults who consider themselves basically healthy. Early care can turn a bizarre medical mystery into a survivable scare rather than a last-minute rescue.