Girl Swallowed a Toothbrush

GODREKR · #1 ● 07-13-2014, 05:42 PM

A 16-year-old female presented to our tertiary care facility two hours following ingestion of a household toothbrush. She admitted to excess alcohol intake the evening prior and have woken feeling “hung-over.” Due to ongoing nausea, she had attempted to induce emesis via manual pharyngeal stimulation with a toothbrush. However, during this process, she claimed to have “choked,” lost control of the toothbrush handle, and ingested the “white-and-orange” toothbrush whole.
Clinical examination revealed a well-appearing 16-year-old female in no distress. Mild pharyngeal abrasions were apparent on examination of the oral cavity. Cardiovascular, respiratory, and abdominal examination proved unremarkable; in particular no abdominal tenderness was reported on manual palpation. Soft tissue lateral X-ray of the neck and chest X-ray revealed no evidence of ingested foreign body.
Endoscopic retrieval of the toothbrush was undertaken in the emergency department. Given the dimension of the ingested foreign body and anticipated requirement for overtube utilization, airway protection was afforded with endotracheal intubation following standard rapid sequence intubation (RSI). Sedation was maintained with propofol/ketamine combination. Gastroscopy was performed with visualization of the distal (brush) end of toothbrush protruding from the gastric outlet, the proximal (handle) having already traversed the pylorus (Figure 1). The brush was snared (Figure 2), and withdrawn en masse with the pictured overtube (Figure 3) to the level of cricopharyngeus. Removal was then completed under direct laryngoscopy with Magills forceps. Relook endoscopy was undertaken with confirmation of nil-induced trauma.

The patient was extubated uneventfully and discharged two hours later in possession of the offending toothbrush. Future manual pharyngeal stimulation for the purposes of inducing emesis was discouraged.