How to connect your liver to your heart with a toothpick

Here's another one in our ongoing series of how to harm yourself by eating toothpicks.

A 55-year old man reported to the hospital with chest pain and a difficulty to breathe when not at rest. The pain was also noticeable when he was lying on his right side. The patient also suffered from a loss of appetite, accompanied by a loss of weight, and did not feel well in general. He was diagnosed with a massive pericardial effusion (a loss of blood from the heart to the surrounding tissue) and a constrictive pericarditis (an inflammation of the sac surrounding the heart). The patient was taken to a computer tomograph which confirmed the pericardial effusion and additionally detected an abscess of the left side of the liver. The scan also showed a tubular structure connecting the liver and the heart which was obviously of foreign origin. A laparotomy (surgical opening of the belly) revealed a wooden toothpick that somehow made its way out of the bowel, through the liver, and partially into the heart. The toothpick was removed and the patient recovered within a week.

The paper also contains a brief literature search which reveals that only 12% of the patients treated for symptoms of a toothpick gone the wrong way remember swallowing that toothpick. That is, only one in about 10 people eating toothpicks are aware of the fact. On the other hand, 80-90% of the cases where people remember swallowing a toothpick are uneventful. Clearly, there are situations that make you less aware of what you put in your mouth (think alcohol), but it still makes me wonder how absentminded you have to be in order not to notice. But then - shit happens.

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