S3690 Emergent Laparotomy to Remove Swallowed Denture That Failed Retrieval Under Endoscopy: A Case Report

Abstract

Introduction: Foreign body ingestion is a common problem for gastroenterologists and general surgeons. Denture aspiration or ingestion is a less common type of ingested foreign body, but may cause hollow viscus necrosis, perforation, penetration to neighbor organs leading to fistula, bleeding, and obstruction. Here, we present a case of ingested metal denture that failed initial attempt to retrieve under esophagogastroduodenoscopy (EGD) and eventually removed by exploratory laparotomy and duodenotomy. Case Description/Methods: A 68-year-old male in Hefei, China presented with one-to-two days of epigastric discomfort. The patient denies any fever, nausea, vomiting, hematochezia, abdominal distention, or abdominal pain. Complete blood count (CBC) showed leukocytosis with a WBC of 15.21 x 109/L, and hemoglobin is within the normal range. Computed tomography (CT) scan showed the swallowed denture in the duodenum. EGD found a metal denture in the descending duodenum. One of the clasps of the denture appeared to penetrate the mucosa and the attempt to retrieve the denture under EGD failed. Therefore, emergent exploratory laparotomy plus duodenotomy to remove foreign body plus adhesiolysis was performed, and the denture was removed without complications. The patient was discharged on post-operation day 7 without complications. Discussion: Metal dentures can be accidentally swallowed and may cause gastrointestinal (GI) bleeding or perforation due to their material and structure such as the clasps. Therefore, consult for the gastroenterologist and possible emergent EGD should be considered early. However, when the denture clasps penetrate the mucosa of the GI organ with a relatively thin wall, such as the duodenum in our case, the attempt to retrieve under EGD should be performed cautiously due to the potential risk of tearing the mucosa leading to further damage. If the attempt under EGD is not successful or risky, consult for surgery should be considered. In this case, based on the request of the patient and his family, surgery was performed immediately without the further attempt of retrieval under EGD.In short, the ingested metal dentures may cause severe consequences such as GI bleeding and perforation, and thus patients with denture loosening visit the dentist as soon as possible. In addition, complications of endoscopic removal such as tears and perforations of the GI tract can not be ignored, therefore it must proceed with cautions and surgical intervention should be considered if needed.Figure 1.: A) The clasps of the swallowed denture penetrated the mucosa of the descending duodenum under esophagogastroduodenoscopy (EDG); B) Cross-section views of Computed tomography (CT) scan obtained from the First Affiliated Hospital of Anhui Medical University, Hefei, China showed the swallowed denture in the duodenum; C) Coronal plane of CT scan obtained from the First Affiliated Hospital of Anhui Medical University, Hefei, China showed the swallowed denture in the duodenum; D) The swallowed denture removed by surgical operation.