1898 Successful Endoscopic Removal of a Long Lost Toothbrush: 15 Years Later!

Abstract

INTRODUCTION: Toothbrush ingestion is uncommon and can sometimes be seen in patients with eating disorders or underlying psychiatric illness. Although some foreign bodies can pass spontaneously, due to its shape, spontaneous passage of toothbrush can be difficult and if left untreated can lead to abdominal pain, mucosal ulceration, bleeding and perforation. We report one such case of a toothbrush accidentally ingested 15 years ago and impacted in the gastric wall that was successfully removed endoscopically. CASE DESCRIPTION/METHODS: A 37-year-old female with past medical history of bulimia and accidental ingestion of tooth brush 15 years ago reported to her PCP with worsening abdominal pain. She had never reported or sought help for her ingested toothbrush all these years due to fear of being labelled mentally ill. Labs were relevant for mild anemia with Hb of 10.5 gm/dl. Initial attempt at endoscopic removal at outside center was unsuccessful. At repeat EGD at our center, a 20 cm long toothbrush was seen in the gastric body covered with significant debris (Figure 1). The distal end of the toothbrush was seen embedded in the proximal gastric wall (Figure 2). Attempts to free the distal end with a snare were not successful. A long overtube was then placed and gastroscope passed through it. Then using a rat tooth forceps the bristle part of the tooth brush was grasped and the brush was pulled into the antrum and the distal end was freed from the gastric wall. No frank perforation was seen at the site of impaction. The tooth brush was then grasped with a snare and brought into the overtube. The endoscope and overtube with the toothbrush were successfully removed (Figure 3). The patient was continued on PPI for 4 weeks and her abdominal pain resolved post procedure. DISCUSSION: Up to 80% of the ingested foreign bodies may pass through the gastrointestinal tract spontaneously. However long objects (>5 cm) cannot pass through the duodenum and need to be removed by endoscopy and rarely by surgery. Those that remain in gastrointestinal tract can be associated with serious complications such as perforation, bleeding, pressure necrosis or obstruction. Toothbrush ingestion is uncommon and requires prompt removal. However our patient sought help after 15 years of ingestion only after it caused abdominal pain. To the best of our knowledge this is the longest time period a toothbrush has been reported retained in the stomach and subsequently successfully retrieved by endoscopy.