In childhood, almost all swallowed objects that successfully navigate the esophagus pass through the gut without complications. In a 15-year-old male adolescent with the initial working diagnosis of acalculous cholecystitis, computed tomography revealed a thickened wall of the second duodenal portion, some infiltration of the periduodenal tissue, and a hyperdense needle-shape structure probably passing through the duodenal wall. Endoscopy revealed a wooden toothpick perforating the duodenum that was carefully retracted. An uneventful recovery followed the endoscopic removal of the foreign body. A computer-based search of the literature to examine the injuries caused by ingested toothpicks since 1960 found only 4 reports in 5 children.