Endoscopic removal of accidentally swallowed dentures

Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients. 80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery. The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist. Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention. In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone. Reference: Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.

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Endoscopic removal of accidentally swallowed dentures

Authors

Gf Donatelli, P Dhumane, C Callari, B Dallemagne, J Marescaux

Abstract

Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.

Keywords

Endoscopy, removal, accidentally swallowed dentures

Media type

Surgical video

Duration

02'02''

Publication

2011-01

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E-publication

WeBSurg.com, Jan 2011;11(01).
URL: http://www.websurg.com/doi-vd01en3191.htm

Endoscopic removal of accidentally swallowed dentures

1. Clinical case presentation 00'19''

A 39-year-old autistic woman accidentally swallowed her dental prosthesis. An X-ray of the abdomen localized the prosthesis to the stomach. The first attempt at endoscopic extraction (performed at another hospital) failed and it was pushed back into the stomach. On the follow-up X-ray performed 3 days afterwards, the prosthesis was seen in the antrum. The patient was transferred to our centre for further care. A repeat X-ray raised concern that the prosthesis had passed into the duodenum. Upper endoscopy to localize the foreign body was postponed to avoid insufflation of the gut in case laparoscopic exploration was required. A subsequent X-ray, however, carried out twelve hours later localized the prosthesis to the stomach.

2. Upper GI endoscopy 01'04''

In the operating room, under general anesthesia in a supine position, upper GI endoscopy was performed with a standard gastroscope. The dental prosthesis was localized in the prepyloric antrum. The endoscope was withdrawn and an end protector hood was inserted that remained inverted during the progression of the scope.

3. Dentures removal 01'24''

Using a rat-tooth forceps, the prosthesis is grasped as straight as possible and slowly pulled back. While passing back through the esophageal sphincter, the hood everts to cover the foreign body. Good vision is maintained and the forceps are closed tightly to be sure that the whole of the foreign body is inside the hood. The hood then protects the esophageal wall and the pharynx from potential injury by the edges of the foreign body. Once at the level of the cricopharyngeus muscle, gentle, constant pressure was maintained on the endoscope for about 30 seconds to let the sphincter relax. The prosthesis was then extracted successfully. Subsequent endoscopy confirmed no iatrogenic damage to the stomach or esophagus.

4. Conclusion 02'09''

We would like to emphasize that the usefulness of using the protective hood, grasping the foreign body in a perpendicular manner in line with the endoscope and gradual relaxation of the esophageal muscles and the cricopharyngeus sphincter are helpful for the successful extraction of foreign bodies.