A 16-year-old male presents with respiratory arrest and bloody pleural effusion. The team discovers multiple bleeding and clotting events affecting lungs, liver, bladder, and spleen. Eventually discovered to be caused by an accidentally swallowed toothpick that penetrated the intestinal wall during movement while making out with his girlfriend, then migrated through multiple organs causing sequential damage.
Also known as: Fluid around the lungs
Initial presentation showing bloody fluid in the pleural space, which was the first clue to the underlying penetrating injury from the migrating toothpick.
Also known as: Blood clot in liver vein
Complete blockage of the hepatic vein discovered during arteriogram, causing liver dysfunction. Initially thought to be a clot but was actually caused by the migrating toothpick creating a mass effect.
Also known as: Bladder bleeding
Massive hemorrhage in the bladder that occurred after initial treatment, part of the sequential organ damage pattern caused by the migrating toothpick.
Also known as: Ruptured spleen
The spleen 'basically exploded' requiring emergency surgery, caused by the toothpick's migration through the organ. External capsule was ruptured but still intact.