Clin Endosc.  2014 May;47(3):254-257. 10.5946/ce.2014.47.3.254.

Intramural Gastric Abscess Caused by a Toothpick Presenting as a Subepithelial Tumor

• Oh WG
• Kim MC
• Yoon HJ
• Park JW
• Yang MA
• Lee CB
• Kim JW
• Cho JW

• KMID: 2049022
• DOI: http://doi.org/10.5946/ce.2014.47.3.254

Abstract

In the present report, we describe an unusual case of an intramural gastric abscess caused by a foreign body, detected in the form of a subepithelial tumor. A 64-year-old woman was referred to our gastroenterology clinic for further evaluation of a gastric subepithelial tumor. The patient presented with a 1-month history of sustained dull epigastric pain. Esophagogastroduodenoscopy revealed an ill-demarcated, round, smooth, protruding lesion with a small central erosion on the great curvature of the proximal antrum. Endoscopic ultrasonography indicated the presence of an ovoid, heterogeneous, hypoechoic lesion with small echogenic foci located in the submucosa and muscularis propria layers. An abdominal computed tomography scan showed focal gastric wall thickening and regional lymph node enlargement. Endoscopic submucosal dissection was performed for definite diagnosis and management. Thus, we detected a toothpick and removed it using grasping forceps. The final diagnosis was an intramural gastric abscess caused by a toothpick.

Keyword

Subepithelial tumor; Gastric foreign body; Toothpick

MeSH Terms

Abscess*
Diagnosis
Endoscopy, Digestive System
Endosonography
Female
Foreign Bodies
Gastroenterology
Hand Strength
Humans
Lymph Nodes
Middle Aged
Surgical Instruments

Figure

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  Fig. 1 Endoscopic findings. An ill-demarcated, round, smooth, protruding lesion with a small central erosion in the great curvature of the proximal antrum.

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  Fig. 2 Endoscopic ultrasonography findings. An ovoid, heterogeneous, hypoechoic mass with small echogenic foci located in the submucosa and muscularis propria layers (arrow).

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  Fig. 3 Abdominal computed tomography scan images. (A) Horizontal view image and (B) sagittal view image show focal gastric wall thickening with heterogeneous enhancement (arrow) and regional lymph node enlargement. Abdominal perforation or major vessel injury was not evident.

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  Fig. 4 Endoscopic submucosal dissection findings. (A) A toothpick that penetrated the antral wall of the stomach. (B) The 3-cm long toothpick, after removal.

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