A 68-year-old male with a complex medical history, including chronic ischemic heart disease (seven prior myocardial infarctions), COPD, and previous duodenal ulcer perforation, presented to the surgical department with acute epigastric pain lasting approximately 24 hours. The onset of pain followed coffee ingestion. On first evaluation, he was hemodynamically stable, afebrile, with a soft, non-tender abdomen, normal bowel sounds, and no peritoneal signs. Laboratory tests revealed CRP 6 mg/L and leukocytes 11.8 ×10³/µL, with otherwise normal liver, pancreatic, renal, and hematologic parameters. Initial abdominal ultrasound and native X-ray were unremarkable, including ECG. The patient was treated with intravenous analgesics and an increased dose of proton pump inhibitor (omeprazole) and discharged with instructions for outpatient follow-up.

Approximately 20 hours later, the patient returned due to persistent epigastric pain. Repeat examination revealed a soft, non-tender abdomen without peritoneal signs. Laboratory testing demonstrated CRP 19 mg/L and leukocytes 11 ×10³/µL, while all other parameters remained within normal limits. Given ongoing symptoms, urgent gastroscopy was performed. During gastroscopy, two flat wooden sticks were noted in the gastric antrum, partially protruding from the mucosa. Upon careful extraction with a loop, they were identified as toothpicks approximately 40 mm in length, each embedded through two-thirds of the gastric wall. Post-procedure, the patient experienced immediate relief of pain. Upon discussion of the findings, the patient recalled having eaten small sandwiches but had not realized that he might have ingested toothpicks. The procedure was completed without mucosal perforation or bleeding. Despite recommendation for hospital observation due to comorbidities and antiaggregation therapy (acetylsalicylic acid + ticagrelor), the patient declined admission. He was discharged under close outpatient follow-up with continuation of omeprazole therapy and a soft diet, without any antibiotic therapy prescribed.

Follow-up evaluation demonstrated complete resolution of symptoms, normal bowel movements, and no gastrointestinal complaints. Repeat abdominal ultrasound and native X-ray showed no abnormalities.

This case illustrates a rare cause of acute epigastric pain—ingestion of sharp foreign bodies—that is often not initially considered, particularly when the patient history does not suggest foreign body ingestion. Prompt recognition and endoscopic retrieval allowed safe management and complete symptom resolution, emphasizing the importance of maintaining a high index of suspicion for unusual etiologies in patients presenting with unexplained abdominal pain.