A penetrating foreign body mimicking pancreatic cancer (with videos)

A 73-year-old male presented with cramping and upper abdomen pain accompanied by fever and unintended weight loss of approximately 8 kg over six weeks. Tests showed elevated transaminase and reactive C-protein levels, along with cholestasis. Imaging initially suggested pancreatic cancer due to a 40 mm irregular mass in the pancreas and portal vein involvement. Endoscopic ultrasound (EUS) and upper gastrointestinal endoscopy revealed the presence of a 60 mm penetrating foreign body (toothpick), mimicking pancreatic cancer. The toothpick was successfully removed endoscopically, and the patient was treated with anticoagulants for portal vein thrombosis. The case highlights the importance of considering rare causes like penetrating foreign bodies in differential diagnoses for pancreatic lesions and underscores the utility of EUS for early diagnosis and minimally invasive treatment.