Successful endoscopic removal of a swallowed toothbrush, a therapeutic challenge. A case report

Abstract

Introduction: Toothbrush swallowing, whether voluntary or accidental, is a rare event and must be handled as an emergency, because these foreign bodies, due to their length and hardness, are not expected to pass completely through the digestive tract and may cause serious complications. Case presentation: A 22-year-old woman with an eating disorder (bulimia nervosa) involuntarily swallowed a toothbrush while inducing vomiting. Unfortunately, after the initial assessment in the emergency department, and due to the lack of symptoms, her psychiatric history, and the fact the toothbrush was not observed in imaging studies, she was discharged. Due to the patient's insistence that she was telling the truth, she was referred to a secondary healthcare institution by her treating physician, where the successful endoscopic extraction of the toothbrush was performed 36 hours after it was swallowed. The procedure was carried out with the patient under sedation and by experts in digestive extraction who used an overtube, foreign body forceps, and polypectomy loops. Conclusion: Cases of toothbrush swallowing are rarely reported and occur mainly in people with mental illnesses, such as eating disorders involving self-induced vomiting. Therefore, in these cases, physicians should always believe what these patients say, even in the absence of symptoms and imaging findings, as this enables their timely referral to a digestive service to confirm whether the toothbrush was swallowed or not and to perform the endoscopic extraction as soon as possible, since it can cause serious complications due to its characteristics.

Keywords

• Toothbrush
• Foreign Bodies
• Upper Gastrointestinal Tract
• Endoscopy