Ingestion of foreign body is commonly encountered in radiological
practice and its significance should not be underestimated [1].
Whenever a dentist loses a dental material or any other foreign object
inside oral cavity, a radiologist must be consulted even if the patient
has no symptoms [4]. Usually, the foreign bodies pass through the GI
tract and are evacuated in 2 to 5 days without symptoms [3]. The two
most common locations of an ingested foreign object at the initial
presentation is in the stomach (58.1%) and small intestine (32.7%)
[5]. Endodontic files have been reported to pass through GI tract
within 3 days, while 10-20% require endoscopic intervention and only in
1% surgery is necessary [6].
Radiographic examination with chest and abdominal x-ray is necessary for
determining the location, size and nature of the ingested foreign object
[7]. The computed tomography (CT) scan can also be used to localize
foreign objects, but it is usually performed to define the exact extent
of injury to the involved organs and the damage to the surrounding
tissues [1]. In our case, the foreign body was radio opaque and the
size assessment was noted. We did not perform a CT scan as the foreign
body was identified in radiography and the patient had normal blood
tests and no symptoms.
Size, sharpness and shape of the ingested foreign body are some
characteristics that should be taken into consideration when a medical
professional has to deal with this condition. The risk of injury
increases when the size of the object is more than 5cm or has a pointed
shape [8].
According to the literature, the removal of a foreign object that has
entered the gastrointestinal tract is determined on the basis of
patients’ age, size shape and location of the object, and time since the
ingestion. The risk of complications such as obstruction or perforation
determines the timing of endoscopy [9]. The overall rate of
perforation caused by ingested foreign bodies is in the range of 1-7 %.
However, the incidence is increased to 15-35%, when pointed or sharp
foreign bodies are considered [10]. According to Bondarde P et al.,
the management of sharp bodies such as endodontic file, when lodged in
GI tract, is endoscopic retrieval or the careful monitoring with
periodic radiographs. If the foreign body does not succeed to progress
after 72 hours or complications such as perforation, obstruction or
bleeding are noticed, surgery should be preferred immediately [4].
In our case, periodic abdominal radiographies were performed for 7 days,
because the patient did not agree to make any endoscopic or surgical
intervention the first 7 days. Oral gastrografin was prescribed for
allowing the rapid transport of the foreign body within the GI tract.
The barium sulfate was not preferred to be used because of its
side-effects such as constipation and mechanical obstruction of bowel,
which can make it difficult to perform endoscopy [11]. In addition,
laxative treatment should be given to patients after barium studies to
reduce the incidence of colonic retention of barium sulfate [12].
Fortunately, the foreign body which was identified as a 2-cm-long dental
bur was successfully removed by gastroenterologists endoscopically 8
days after the ingestion.
Conclusion
Iatrogenic accidents during routine dental procedures are common and
unpredictable. Early recognition and diagnosis of this condition is the
key to prevent serious complications. In 10-20% of these cases
endoscopic intervention is necessary and less than 1% of patients
require surgical retrieval. In our case the foreign body was removed by
gastroenterologists endoscopically.