Case Report

An 84-year-old male with atrial fibrillation, hypertension and type 2 diabetes mellitus was brought to the emergency room of our hospital by a private dental practitioner. The dentist disclosed that a 2-cm dental bur was swallowed accidentally by his patient 2 hours ago during the dental procedure. On examination, the patient’s temperature was 36.5, heart rate was 71 beats per minute, blood pressure was 151/87 and respiratory rate was 17 breaths per minute. His abdomen was soft, without distension and with no evidence of palpable mass. His routine blood tests including haemogram, C-reactive protein level, liver and renal function test, serum amylase and lipase were normal. Chest radiography showed no evidence of free air and no other abnormalities. X-ray of the abdomen revealed a hyperdense, foreign body in the left lower quadrant (Fig. 1A). Upper endoscopy was not performed as the foreign body was shown distal to stomach – not accessible to endoscopy.
Patient was kept under close observation in the department of surgery. He was kept under high fibrous diet and 20ml of oral gastrografin was prescribed every 8 hours for allowing the rapid transport of the foreign object within the gastrointestinal (GI) tract. Serial radiographic examinations were performed to monitor the migration of the ingested foreign body. A repeated x-ray of the abdomen was taken 24 hours after the ingestion of the object. This radiograph suggested the presence of the foreign body in the right lower quadrant of the abdomen (Fig. 1B). As the patient did not agree to make any endoscopic or surgical intervention, abdominal radiographies were performed 48 hours (Fig.1 C), 72 hours (Fig.1 D), 5 days (Fig.1 E) and 7 days (Fig.1 F) after the foreign body ingestion, but the object remained in the same position.
An attempt was made by gastroenterologists to remove the foreign body endoscopically. Eventually, anterograde colon preparation and colonoscopy was performed. The foreign body was detected in terminal ileum, was grasped with an endoscopic loop, pulled through the valve and removed per anus. The length of the dental bur was about 2 cm. The patient did not have any complication and he was mobilized 2 hours after the foreign body removal. He was started on oral diet 12 hours afterwards and was discharged home in a very good condition 24 hours after the endoscopy.