Colonoscopic Extraction of Swallowed Partial Denture Impacted in the Ileocecal Valve

Abstract

INTRODUCTION: Ingestion of dental prostheses is not an uncommon phenomenon with most complications resulting from esophageal impaction. We present a rare case of impaction in the distal gastrointestinal tract and provide the first video submission of such an extraction. CASE REPORT: A 62-year-old male with past medical history of coronary artery disease with stent placement in 2015, gout, and alcohol abuse complicated chronic pancreatitis was admitted to our medical center for acute on chronic pancreatitis in setting of continued alcohol abuse. While being treated, he accidentally ingested his lower mandibular dentures. Upper endoscopy (EGD) was performed, but the foreign body was not seen. Abdominal x-rays demonstrated the dentures had migrated to the mid jejunum without evidence of obstruction. Serial imaging revealed that the dentures were in the right lower quadrant, presumably in the cecum or terminal ileum (Figure 1) and remained there for four consecutive days by imaging, again without obstruction clinically nor by imaging. The decision was made to pursue colonoscopy for foreign body retrieval, which revealed the foreign body protruding from the ileocecal valve (Figure 2A). The protruding end of the denture was retrieved using an endosnare and removed without incident (Figure 2B-2C).Figure: KUB showing denture in right lower quadrant of the abdomen.Figure: Denture at the ileocecal valve (A); denture ensnared (B); denture after removal (C).DISCUSSION: The accidental ingestion of dental prostheses is not uncommon, especially in adults with old and/or poorly maintained dentures. Case series have demonstrated that 11.5-17.6% of impacted foreign bodies involved dental prostheses. The most common site of impacted dentures is in the esophagus, and while many are passed spontaneously with no need for endoscopic or surgical intervention, there are rare cases of impaction at the level of the ileocecal valve, cecum, appendix, ascending colon, and transverse colon, and sites of frequent perforation include the ileocecum and rectosigmoid colon, owing to the acute angulation or physiologic narrowing of the tract. Endoscopic removal via colonoscopy is typically successful in these cases.Figure: Fluoroscopic image prior to removal of denture (Left). Fluoroscopic image after removal (Right).