Foreign body ingestion is an accidental or an intentional event, with most of the ingested foreign bodies passing spontaneously through the gastrointestinal tract without incidents. About 10-20% of them, especially long and sharp objects like toothpicks, will fail to pass through the entire gastrointestinal tract and may cause symptoms. Toothpick injury of the gastrointestinal tract is often associated with considerable morbidity and mortality. The complications that can be caused by toothpick ingestion are obstruction, perforation, hemorrhage, fistula formation, small bowel inflammation, sepsis and even death. Diagnosis of toothpick injury can be difficult as there are no specific physical findings or laboratory examinations which may aid the diagnosis and even imaging studies are of little help as wooden toothpicks are radiolucent. We report a rare case of incidental toothpick ingestion which caused an ileum fistula and mimicked Crohn's disease.