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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 105-107

Esophageal perforation by swallowing of removable partial denture


Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication25-Oct-2016

Correspondence Address:
Ritu Dhawan Galhtora
96, Lal Bagh, Near Rajguru Nagar, Post Office Threeke, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.192979

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  Abstract 

Ingestion of Foreign body whether intensional or inadvertent is a common cause of esophageal perforation. Any delay in the diagnosis or treatment can lead to respiratory compromise, sepsis, or hemorrhage. Any complications in the gastrointestinal tract, primarily in the esophagus may requires an urgent approach. If the treatment is delayed more than 24 hrs, the mortality rate may approach to 21%. Among the various causes, coins are the most commonly seen foreign body in the esophagus in children, in adults are the solid components of meals, like bones, and in the elderly population loose tooth or dental prostheses are the most frequently observed ingested foreign bodies. Swallowed Dental prosthesis causing esophageal perforation are commonly encountered in elderly , however they can be seen in any age group using them. Thus, the aim of this report was to present one of these interesting case of esophageal perforation due to a denture ingestion and its treatment in a 42-year-old male.

Keywords: Dental prosthesis, endoscopy, esophagus, foreign body, perforation


How to cite this article:
Galhtora RD, Galhotra V, Attri A, Jassi P, Gupta K. Esophageal perforation by swallowing of removable partial denture. J Dent Allied Sci 2016;5:105-7

How to cite this URL:
Galhtora RD, Galhotra V, Attri A, Jassi P, Gupta K. Esophageal perforation by swallowing of removable partial denture. J Dent Allied Sci [serial online] 2016 [cited 2021 Jun 18];5:105-7. Available from: https://www.jdas.in/text.asp?2016/5/2/105/192979


  Introduction Top


Foreign body ingestion is a common occurrence in any age group, but majority of foreign bodies that reach the gastrointestinal (GI) tract pass spontaneously.[1] Esophageal foreign bodies account for approximately 20% of all GI foreign bodies and are encountered more often in childhood but can also be seen in adults and the elderly.[2] 10%–20% of the patients require nonoperative intervention, and 1% or less require surgery. Serious complications such as retropharyngeal or paraesophageal abscess and mediastinitis can occur, following foreign body ingestion requiring urgent intervention. Cases of swallowed dental prostheses are occasionally reported in the medical and dental literature. The diagnosis of an inadvertently swallowed foreign body is usually delayed. The ingestion may not result in any sign or symptom, and the denture may be found totally by chance.[1] The common foreign bodies found in the esophagus among children are coins, swallowing of toy parts, and alkaline batteries. In adults, the most frequently observed ingested foreign bodies are meat in meals and fish bones. Dental prostheses in the elderly population, especially in patients with dementia, can create serious problems and appear to be the most commonly ingested foreign bodies in this population.[2]


  Case Report Top


We go to discuss the case of a 42-year-old male who presented with a history of accidental ingestion of tooth with dental prosthesis while taking some medication following which patent complaints of throat pain. He was admitted to some local hospital where upper GI endoscopy was done, in which they found tooth impacted in the postcricoid region and they could not remove it. Then, the patient was referred to our hospital. No history of stridor, shortness of breath, dysphagia, and fever was present. His vitals were stable with blood oxygen saturation of 100%. Cervical spine anteroposterior and lateral X-rays were done which did not reveal any foreign body. Flexible esophagoscopy was done by ENT surgeon under general anesthesia and a tooth with sharp edges was identified in the postcricoid region. Tooth was tried to remove but could not as it was impacted. On spot cervical exploration was done to remove the tooth, but tooth was not found in its place possibly pushed distally in the esophagus. Then, after the cervical wound was closed, computed tomography (CT) of the neck and chest was done to locate the tooth. The patient was stable with vitals of 100/70, pulse rate of 60, and blood oxygen saturation of 99%. CT confirmed that the foreign body located in the right lung with evidence of esophageal perforation and right hydropneumothorax [Figure 1], [Figure 2], [Figure 3]. Surgery was done on the next day which reveals esophageal rent of 2–3 cm with tooth protruding out through it. The rent was repaired, and the patient was discharged after a few days in a healthy condition.
Figure 1: Axial, coronal, sagittal images – mediastinal window show radiopaque foreign body of metallic density in relation to the right side of thoracic esophagus

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Figure 2: (a and b) Axial computed tomography images – mediastinal and lung window showing pneumomediastinum

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Figure 3: Axial contrast-enhanced computed tomography images – lung and mediastinal window showing right-sided pneumothorax and bilateral effusion (R>L)

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  Discussion Top


According to the National Health and Nutrition Examination Survey-III, 1 of every 5 persons between the ages of 18 and 74 years has full or partial dentures. The inadvertent swallowing of a dental prosthesis is not uncommon in the adult population. In a study by Abdullah et al. of 200 patients with a known history of an impacted tracheal or esophageal foreign body, dental prostheses accounted for 11.5% of the cases.[3]

Foreign body ingestion causing esophageal perforation can occur in approximately 7%–14% of esophageal perforations.[4] Coins are the most common ingested foreign body in children; however, among adult patients, fish and chicken bones are the most common etiologies. In elderly people, dental prosthesis and loose tooth are commonly ingested while having meal.[2]

Most commonly, the laceration or perforation occurs in the normal anatomic narrowing of the esophagus. These narrowing points typically occur at the cricopharyngeal muscle of the upper esophageal sphincter, level of the aortic arch, left main stem bronchus, and lower esophageal sphincter. Up to 5% of patients may present with acute airway obstruction when the foreign body is impacted near the upper esophageal sphincter, causing compression of the trachea.[5]

Patients may be symptomatic immediately or as late as 2 weeks after the esophageal perforation. Chest pain and discomfort are the most common symptoms of an esophageal injury. The initial investigation of choice for localizing foreign body is chest X-ray which may reveal perforation-related complications, such as air, fluid collection, or abscess, in the pleural space, pericardium, or mediastinum. However, chest X-ray may not be adequate to detect the retained esophageal foreign body and can be normal in some cases. Chest X-ray helps to identify the type of foreign body and to plan the treatment.[4] Eighty percent of foreign bodies can be identified on direct radiography.[2] The most sensitive procedure to examine the retained esophageal foreign body and evaluate the esophageal injury is upper GI endoscopy. To assess the complications related to the esophageal perforation, CT should also be obtained. Although the primary treatment for esophageal perforation is surgical, conservative management including endoscopic therapies may be appropriate in individualized cases.[4]

The reported mortality from treated esophageal perforation is 10%–25% when therapy is initiated within 24 h of perforation, and it is 40%–60% when the treatment is delayed.[6] The treatment of esophageal perforation is controversial. Recently, it has been found that patients with small, well-defined tears and minimal extraesophageal involvement may be better managed by nonoperative treatment.[6]

Dysphagia, neck pain and tenderness, hypersalivation, regurgitation, retrosternal discomfort, and odynophagia are the common complaints the patients have after foreign body ingestion. Perforation of the esophagus is usually caused by sharp edged objects. Esophagogastroscopy primarily performed for extraction of the foreign objects located in the upper GI tract. If any complication occurs during or after endoscopy or in case of failure of endoscopy, a rapid decision for open surgery is to be considered. In the case of the swallowing of prostheses, there are no differences in the diagnostic and therapeutic approach from that taken for other foreign bodies of the esophagus. If a perforation or late complication occurs, a close follow-up is mandatory in addition to perfect open surgical treatment, adequate antibiotics, and total parenteral nutrition. A rapid and aggressive approach can certainly reduce the mortality and morbidity.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chrcanovic BR, Custodio AL. Swallowed partial denture: A case report and a literature review. Arq Bras Odontol 2010;6:19-24.  Back to cited text no. 1
    
2.
Tihan D, Trabulus D, Altunkaya A, Karaca S, Cihan A, Alis H. Esophageal perforation due to inadvertent swallowing of a dental prosthesis. Turk J Gastroenterol 2011;22:529-33.  Back to cited text no. 2
    
3.
Haidary A, Leider JS, Silbergleit R. Unsuspected swallowing of a partial denture. AJNR Am J Neuroradiol 2007;28:1734-5.  Back to cited text no. 3
    
4.
Li N, Manetta F, Iqbal S. Endoscopic management for delayed diagnosis of a foreign body penetrating the esophagus into the lung. Saudi J Gastroenterol 2012;18:221-2.  Back to cited text no. 4
  Medknow Journal  
5.
Wu JT, Mattox KL, Wall MJ Jr. Esophageal perforations: New perspectives and treatment paradigms. J Trauma 2007;63:1173-84.  Back to cited text no. 5
    
6.
An JS, Baek IH, Chun SY, Kim KO. Successful endoscopic band ligation of esophageal perforation by fish bone ingestion. J Laparoendosc Adv Surg Tech A 2013;23:459-62.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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