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Accidentally Swallowing a Toothbrush in a Patient during a Vomiting Attempt: Literature Review and Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052682. [PMID: 35270374 PMCID: PMC8910308 DOI: 10.3390/ijerph19052682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023]
Abstract
Swallowing a whole toothbrush is a rare event. As of today, no case described has documented that the foreign body has passed through the entire gastrointestinal tract and has been spontaneously eliminated. Places where it is most frequently retained have been described. Only in one single case described did the foreign body reach the colon. We describe the main injuries caused by this foreign body, and the most common correct therapeutic approach for solving the problem. The third case in the literature is presented, with diagnosis and treatment of a woman who, in an attempt to induce vomiting, swallowed a toothbrush which became lodged in her stomach. The patient, at the time of the examination, only showed abdominal pain and anxiety.
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2
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Accidental or intentional ingestion of toothbrushes: experience with 8 adult patients. Emerg Radiol 2022; 29:377-382. [PMID: 35022861 DOI: 10.1007/s10140-021-02009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ingestion of a toothbrush is an unusual event but may occur either accident or by intent. Radiological examinations play a crucial role in determining the exact location of the object within the gastrointestinal tract and in planning for its removal by endoscopic or surgical intervention. METHODS Medical and radiological records of 8 patients who had swallowed the broken heads or entire toothbrush were retrospectively reviewed. This series included 4 men and 4 women, ranging in age from 21 to 57 years (mean: 34 years). RESULTS Radiographs and computed tomography of the abdomen demonstrated the ingested toothbrushes within the stomach in 3, lodged in the duodenum in 1, and entrapped in various parts of the colon in 4 patients. They were removed by laparotomy in 3, laparoscopy in 2, colonoscopy in 2, and upper gastrointestinal endoscopy in 1 patient. There were no perforations or associated complications, and all patients had uneventful recoveries. CONCLUSIONS Ingested toothbrushes can be easily identified on radiological studies because of the radiopaque wires holding the nylon bristles. The plastic parts of it, however, are only visible on computed tomography. All cases would require endoscopic or surgical removal of the retained toothbrushes because spontaneous passage per rectum does not occur.
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Klancnik M, Grgec M, Perković N, Ivanišević P, Poljak NK. A Foreign Body (Toothbrush) in the Esophagus of a Patient with Hiatal Hernia. Case Rep Gastroenterol 2017; 11:184-189. [PMID: 28512391 PMCID: PMC5422728 DOI: 10.1159/000464277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/29/2022] Open
Abstract
Toothbrush ingestion is rare and most commonly seen in patients with psychiatric comorbidities and in young women with a medical history of eating disorders who try to induce emesis. Long ingested objects, such as a toothbrush, cannot pass the gastrointestinal tract spontaneously and require endoscopic removal or even a surgical approach in cases of unsuccessful endoscopic removal or complication development. We present a case of a 71-year-old male with hiatal hernia without psychiatric or neurological comorbidity who accidentally ingested a toothbrush during oral hygiene routine. After X-ray confirmation, the toothbrush was removed endoscopically.
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Affiliation(s)
- Marisa Klancnik
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Maja Grgec
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Nikola Perković
- bClinical Department for Internal Medicine, Division of Gastroenterology, Split University Hospital Center, Split, Croatia
| | - Petar Ivanišević
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Nikola Kolja Poljak
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
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4
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Yahya A, Chukwuma J. Retrospective Audit of the Management of Anal Insertion of Foreign Bodies: A Holistic Approach. Prim Care Companion CNS Disord 2016; 18:15br01864. [PMID: 27247831 DOI: 10.4088/pcc.15br01864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022] Open
Abstract
Most patients with voluntary anal insertion of a foreign body (IFB) present to the emergency department and are then managed by the surgical team. This report reviews the medical literature on IFB and includes results of a chart review of operative logged interventions and clinically coded procedures for anal IFBs at a single acute hospital in the United Kingdom between May 2009 and September 2013. The objective was to establish the current practice in the management of anal IFB and update a framework for the initial workup, surgical procedure, and appropriate mental health intervention.
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Affiliation(s)
- Ahmed Yahya
- Department of Psychiatry, Chase Farm Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, Middlesex, United Kingdom
| | - Jude Chukwuma
- Department of Psychiatry, Chase Farm Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, Middlesex, United Kingdom
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Forney KJ, Buchman-Schmitt JM, Keel PK, Frank GK. The medical complications associated with purging. Int J Eat Disord 2016; 49:249-59. [PMID: 26876429 PMCID: PMC4803618 DOI: 10.1002/eat.22504] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. METHOD Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. RESULTS Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. DISCUSSION Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder.
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Affiliation(s)
- K. Jean Forney
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Guido K.W. Frank
- Department of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO
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Kim YH, Cho SI, Do NY, Park JH. A case of pharyngeal injury in a patient with swallowed toothbrush: a case report. BMC Res Notes 2014; 7:788. [PMID: 25374403 PMCID: PMC4233075 DOI: 10.1186/1756-0500-7-788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/22/2014] [Indexed: 01/19/2023] Open
Abstract
Background Otolaryngologists encounter cases of various foreign bodies in the oral and pharyngeal regions. One commonly found foreign body is a fish bone, ingested in most cases by carelessness or an accident. These foreign materials are removed by endoscopy or through a simple procedure. However, hypopharyngeal damage is rarely caused by a foreign body in the pharynx following the swallowing of a toothbrush. Case presentation A 44-year-old Asian male visited the emergency room with chief complaints of intraoral pain and dysphagia that had started on the same day. The patient had paranoid-type schizophrenia that began 10 years ago; he had been hospitalized and was being treated at another clinic, and was transferred to the emergency room by the medical staff after swallowing a toothbrush. We successfully removed a toothbrush located within the pharynx of a patient with a history of a psychologic disorder via surgery and conservative treatment. Conclusion The case with this patient, and a rapid diagnosis as well as treatment is imperative. The presence and state of a foreign body must be determined through a careful physical examination and imaging, followed by the immediate removal of the foreign body, all while keeping in mind the possibility of accompanying damage to nearby tissues.
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Affiliation(s)
| | | | | | - Jun-Hee Park
- Department of Otolaryngology-Head and Neck surgery, Chosun University, 365 Pilmun-daero, Dong-gu, Gwanju 501-717, South Korea.
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Abstract
AIM To systemically collect and summarize the literature on case reports concerning adverse events associated with the oral use of a toothbrush. MATERIALS AND METHODS Two electronic databases were searched for articles published up to October 2013 to identify appropriate studies using focused search terms and 'case reports' as a filter. Results. A comprehensive search identified 419 unique titles and abstracts. Ninety-four studies met the eligibility criteria. In total, 118 subjects (age range = 1-60 years) presented adverse events related to the oral use of a toothbrush. Events could be summarized in five categories, of which ingestion was the most reported problem among the individuals (50 cases). This was followed by impaction of a toothbrush (27 cases). Reports more frequently involved females and children were more likely to have injuries compared to males and adults. Most of the cases that presented with adverse events of the oral use of a toothbrush were referred for treatment to a physician. CONCLUSIONS The combined evidence related to serious adverse events as presented in case reports showed that the oral use of a toothbrush can be associated with ingestion, impaction, instant trauma, gingival traumatic injury and seizures. Given the incidence of reporting, important recommendations are that a toothbrush should not be used to induce vomiting, nor should people walk or run with this device in their mouths, especially children.
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Affiliation(s)
- Sara Cioccari Oliveira
- Department of Periodontology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam , The Netherlands
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Herrera DA, Pollock AN. Intentional insertion of a foreign body in the tongue in a patient with polyembolokoilamania. Pediatr Emerg Care 2014; 30:368-9. [PMID: 24786997 DOI: 10.1097/pec.0000000000000157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Diego A Herrera
- From the *Department of Radiology, Universidad de Antioquia, Medellin, Colombia; and †Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Hermont AP, Pordeus IA, Paiva SM, Abreu MHNG, Auad SM. Eating disorder risk behavior and dental implications among adolescents. Int J Eat Disord 2013; 46:677-83. [PMID: 23625589 DOI: 10.1002/eat.22132] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the occurrence of tooth erosion (TE) and dental caries (DC) in adolescents with and without risk behavior for eating disorders (EDs). METHOD A controlled cross-sectional study involving 1,203 randomly selected female students aged 15-18 years was conducted in Brazil. Risk behavior for EDs was evaluated through the Bulimic Investigatory Test of Edinburgh and dental examinations were performed. RESULTS The prevalence of risk behavior for EDs was 6%. Twenty adolescents (1.7%) were identified with severe risk behavior for EDs and matched to 80 adolescents without such risk. Among the severe risk group, 45% of adolescents were affected by TE and 80% by DC compared with 8.8 and 51.3%, respectively, in the matched group. Adolescents with severe risk had higher chances for TE (OR = 10.04; 95% CI = 2.5-39.4). DISCUSSION In this study, a severe risk behavior for EDs was significantly associated with TE, but not with DC.
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Affiliation(s)
- Ana Paula Hermont
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Abstract
OBJECTIVE Eating disorders, such as anorexia nervosa and bulimia nervosa, are often undiagnosed but potentially treatable illnesses that, if not identified, can lead to morbidity and death. Often, because of embarrassment or social stigma, patients do not readily admit to these disorders when interviewed by caregivers. Imaging findings can suggest the presence of an eating disorder; understanding these findings allows the radiologist to contribute to the diagnosis of these insidious conditions and alert the referring caregiver. Current concepts in eating disorders and their multimodality imaging findings in several organ systems will be reviewed. CONCLUSION After reviewing this article, the radiologist will understand the imaging findings in eating disorders. This knowledge will empower the radiologist to raise the question of a patient's eating disorder, a condition that may be unsuspected by the referring caregiver and could otherwise remain undiagnosed.
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Sewpaul A, Shaban F, Venkatasubramaniam AK, Tennant D, Kelly SB. The case of the forgotten toothbrush. Int J Surg Case Rep 2012; 3:184-5. [PMID: 22406347 DOI: 10.1016/j.ijscr.2012.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 01/15/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Although foreign body ingestion is relatively common, toothbrush swallowing is rare. A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. PRESENTATION OF CASE We report a case of a swallowed toothbrush which passed past the pylorus and perforated the terminal ileum. The patient however presented with a fluctuant mass in the left iliac fossa, pyrexia and generalised tenderness mimicking a diverticular abscess. DISCUSSION Ingestion of a foreign body is commonly encountered in the clinic among children, adults with intellectual impairment, psychiatric illness or alcoholism, and dental prosthetic-wearing elderly subjects. However, toothbrush swallowing is rare, with only approximately 40 reported cases. CONCLUSION Bowel perforation by foreign bodies can mimic acute appendicitis and should be considered in differential diagnoses. Clinically, patients often do not recall ingesting the foreign body, which makes the clinical diagnosis more challenging, and a correct diagnosis is frequently delayed. Several radiological investigations, such as small-bowel series, ultrasonography, and computed tomography scans, may lead to the correct diagnosis, but in most patients, the diagnosis is not confirmed until the surgical intervention has been performed.
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Affiliation(s)
- A Sewpaul
- Department of General Surgery, North Tyneside General Hospital, Rake Lane North Shields NE29 8NH, United Kingdom
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Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012; 14:11f01192. [PMID: 22690353 DOI: 10.4088/pcc.11f01192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 12/17/2022] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts.Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article.
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Gowda D, Familua O, Sathyanarayana N. Toothbrush Ingestion Leading to Laparotomy. Am Surg 2010. [DOI: 10.1177/000313481007601101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dinesh Gowda
- Columbia University College of Physicians and Surgeons Harlem Hospital Center New York, NY
| | - Oluwamayowa Familua
- Columbia University College of Physicians and Surgeons Harlem Hospital Center New York, NY
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14
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Abstract
A rare case is reported with a large foreign body in the upper gastrointestinal tract. A 19-year-old girl accidentally swallowed her toothbrush which was successfully removed via endoscopy using a polypectomy snare under topical pharyngeal anesthesia. The extracted toothbrush was 20 cm long, and it had the characteristic radiographic image.
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Affiliation(s)
- Xin-Liang Lu
- Department of Gastroenterology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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15
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Cox D, Donohue P, Costa V. A swallowed toothbrush causing perforation 2 years after ingestion. Br J Hosp Med (Lond) 2007; 68:559. [PMID: 17974307 DOI: 10.12968/hmed.2007.68.10.27330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Cox
- Emergency Department, Charing Cross Hospital, London
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Abstract
Toothbrush swallowing is a rare event. Because no cases of spontaneous passage have been reported, prompt removal is recommended to prevent the development of complications. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients, and there has been no previously reported case of a toothbrush in the colon. Here, we report a case of a swallowed toothbrush found in the ascending colon that caused a fistula between the right colon and the liver, with a complicating small hepatic abscess. This patient was successfully managed using exploratory laparotomy. To our knowledge, this is the first documented case of a swallowed toothbrush found in the colon.
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Affiliation(s)
- In Hee Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Hyun Chul Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Kang Hun Koh
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Seong Hun Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Seung Ok Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Korea
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Abstract
Although foreign body ingestion is relatively common, toothbrush swallowing is rare. We report a case of a swallowed toothbrush which passed through the ileocecal valve and perforated the proximal transverse colon, then the liver. To our knowledge, this is the first case to be reported.
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Affiliation(s)
- Min-Ro Lee
- Department of Surgery, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk 561-180, South Korea
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Affiliation(s)
- J Faust
- Department of Medicine, Gutenberg-University Mainz, Germany.
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Abstract
Two girls accidentally swallowed their toothbrush while inducing emesis; both had bulimia. Early removal of the brush is advised to prevent complications. Endoscopic removal is the preferred method, but because of the toothbrush's geometric qualities, surgical retrieval is often required.
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Affiliation(s)
- D T Wilcox
- Department of Surgery, State University of New York at Buffalo, School of Biomedical and Medical Sciences
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