Case report: Duodenal perforation caused by an ingested toothbrush handle

Accidental swallowing of foreign bodies occurs in children and adults. The majority of ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, in some patient, the ingested foreign body may cause impaction, perforation, or obstruction of the gastrointestinal tract.

The research team led by Dr. Tzu-Chieh Chao from Taiwan report a rare case of duodenal perforation caused by an ingested 12-cm long toothbrush handle. This will be published on July 21, 2008 of the World Journal of Gastroenterology.

A 22-year-old female experienced nausea and foreign body sensation in the throat. She attempted to induce vomiting by irritating the pharynx with the distal end of a toothbrush handle. The toothbrush broke at the junction of the handle and the brush head. Unfortunately, she accidentally swallowed the handle of the broken toothbrush, which was 12 cm in length. Doctors attempted to remove the swallowed toothbrush by endoscopy, but failed. Surgery was then performed and revealed a perforation in the duodenum.

Children usually swallow foreign bodies because of carelessness. In adults, poor vision, mental disease, drug addiction, wearing of dentures, and rapid eating have been implicated as the etiologic factors of foreign body ingestion. Although a conservative approach toward foreign body ingestion is justified, early endoscopic removal of the ingested foreign body from the stomach is recommended. However, the successful endoscopic approach depends on the size and shape of the ingested foreign bodies. In cases of unsuccessful removal of gastric foreign bodies, surgical removal of these should be considered.

Reference: Chao HH, Chao TC. Perforation of the duodenum by an ingested toothbrush. World J Gastroenterol 2008; 14(27):4410-4412
http://www.wjgnet.com/1007-9327/14/4410.asp

Correspondence to: Dr. Tzu-Chieh Chao, Department of Surgery, Chang Gung Memorial Hospital, 5 Fuhsing Street, Kweishan, Taoyuan 33305, Taiwan, China. tcchao@adm.cgmh.org.tw
Telephone: + 886-33281200-3219 Fax: +886-33285818

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