A 40-Year-Old Man With 2-Year Chronic Epigastric Pain From a Retained 18-cm Toothbrush: Endoscopic Management and Clinical Decision-Making.
Source: PubMed, NCBI / U.S. National Library of Medicine
BACKGROUND Foreign body ingestion is common in children, whereas ingestion of non-food objects in adults is uncommon. Toothbrush ingestion is particularly rare. Because of their length and rigidity, toothbrushes are unlikely to pass spontaneously through the gastrointestinal tract and can cause pressure injury, ulceration, perforation, or fistula if retained. We report a case of chronic epigastric pain caused by long-term retention of a swallowed toothbrush and highlight the value of endoscopy when radiologic findings appear more severe than the clinical presentation. CASE REPORT A 40-year-old man presented with intermittent epigastric pain for 2 years. After repeated questioning, he reported accidentally swallowing an 18-cm plastic toothbrush during alcohol intoxication 20 years earlier. Contrast-enhanced computed tomography (CT) performed at another hospital demonstrated a linear foreign body extending from the gastric antrum to the descending duodenum, with suspected adhesion to the liver and possible sinus tract formation. However, the patient had no fever, peritoneal signs, or other evidence of major intra-abdominal complications. Because the concerning imaging findings were not consistent with the relatively benign clinical picture, and because the patient requested diagnostic confirmation before surgery, upper endoscopy was performed. The toothbrush was identified and removed intact with a polypectomy snare. Follow-up endoscopic inspection showed no perforation, fistul
Abstract
BACKGROUND Foreign body ingestion is common in children, whereas ingestion of non-food objects in adults is uncommon. Toothbrush ingestion is particularly rare. Because of their length and rigidity, toothbrushes are unlikely to pass spontaneously through the gastrointestinal tract and can cause pressure injury, ulceration, perforation, or fistula if retained. We report a case of chronic epigastric pain caused by long-term retention of a swallowed toothbrush and highlight the value of endoscopy when radiologic findings appear more severe than the clinical presentation. CASE REPORT A 40-year-old man presented with intermittent epigastric pain for 2 years. After repeated questioning, he reported accidentally swallowing an 18-cm plastic toothbrush during alcohol intoxication 20 years earlier. Contrast-enhanced computed tomography (CT) performed at another hospital demonstrated a linear foreign body extending from the gastric antrum to the descending duodenum, with suspected adhesion to the liver and possible sinus tract formation. However, the patient had no fever, peritoneal signs, or other evidence of major intra-abdominal complications. Because the concerning imaging findings were not consistent with the relatively benign clinical picture, and because the patient requested diagnostic confirmation before surgery, upper endoscopy was performed. The toothbrush was identified and removed intact with a polypectomy snare. Follow-up endoscopic inspection showed no perforation, fistula, or active bleeding. The epigastric pain resolved immediately after removal. CONCLUSIONS This case shows that endoscopic evaluation is important in patients with retained gastrointestinal foreign bodies, especially when cross-sectional imaging may overestimate the extent of injury. Endoscopy can clarify the diagnosis and provide definitive treatment while avoiding unnecessary surgery.