Man 74 yo with epigastric pain, being treated like gastric ulcer.
Ultrasound of abdomen detected one hyperechoic foreign body # 3.5 cm which penetrated gastro-duodenum wall to gallbladder. The gallblader wall is very thick # 1 cm.
MSCT of abdomen made diagnosis that was a toothpick penetrated from gastric wall to gallbladder.
Operation removed this toothpick and cholecystectomy.
Conclusion: Toothpick perforated gastric wall to gallbladder, an emergency case must be known.