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A49-year-oldmanpresented to our hospital with upper abdominal pain which had lasted for the previous 5 days. The pain was not accompanied by nausea or emesis but was more intense after he had consumed dry, hard food. Gastroscopy at another hospital showed a toothpick embedded in the duodenal flexure (●" Fig.1). Whenadmitted toourhospital, thepatient reported hematuria without urinary frequency, urgency or odynuria. His vital signs were stable and his abdomen was soft. There was slight tenderness on the left upper quadrant with no rebound tenderness. Complete blood count and blood chemistry were normal. An abdominal computed tomography (CT) scan showed a hyperdense needle-shaped structure penetrating the duodenal wall and into the right kidney (●" Fig.2). Contrast enhanced CT demonstrated no vessel injury or hematoma. An attempt to remove the toothpick endoscopically was unsuccessful because the toothpick was not located (●" Fig.3). A repeat abdominal CT showed that the toothpick was still present in the duodenum (●" Fig.4). The patient then underwent exploratory laparotomyand duodenorrhaphy. During surgery, a 6.5-cm toothpick was found (●" Fig.5). His postoperative recovery was uneventful and he was discharged after a week. Diagnosis of gastrointestinal foreign bodies is sometimes very difficult. Some patients do not remember swallowing foreign bodies and can then present with nonspecific symptoms or symptoms Fig.2 Abdominal computed tomography (CT) showed a hyperdense needle-shaped structure penetrating the duodenal wall and into the right kidney.

Kidney injury and hematuria as a result of duodenal perforation by an ingested toothpick