Sewpaul A, Shaban F, Venkatasubramaniam A K, Tennant D, Kelly S B
Department of General Surgery, North Tyneside General Hospital, Rake Lane North Shields NE29 8NH, United Kingdom.
Int J Surg Case Rep. 2012;3(5):184-5. doi: 10.1016/j.ijscr.2012.01.008. Epub 2012 Feb 6.
Although foreign body ingestion is relatively common, toothbrush swallowing is rare. A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis.
We report a case of a swallowed toothbrush which passed past the pylorus and perforated the terminal ileum. The patient however presented with a fluctuant mass in the left iliac fossa, pyrexia and generalised tenderness mimicking a diverticular abscess.
Ingestion of a foreign body is commonly encountered in the clinic among children, adults with intellectual impairment, psychiatric illness or alcoholism, and dental prosthetic-wearing elderly subjects. However, toothbrush swallowing is rare, with only approximately 40 reported cases.
Bowel perforation by foreign bodies can mimic acute appendicitis and should be considered in differential diagnoses. Clinically, patients often do not recall ingesting the foreign body, which makes the clinical diagnosis more challenging, and a correct diagnosis is frequently delayed. Several radiological investigations, such as small-bowel series, ultrasonography, and computed tomography scans, may lead to the correct diagnosis, but in most patients, the diagnosis is not confirmed until the surgical intervention has been performed.
尽管异物摄入相对常见，但吞入牙刷却较为罕见。术前很少能诊断出由尖锐或带尖的异物导致的小肠穿孔，因为临床症状通常不具有特异性，可能会与其他外科病症相似，如阑尾炎和憩室炎。
我们报告一例吞入的牙刷通过幽门并导致回肠末端穿孔的病例。然而，该患者表现为左下腹有一波动肿块、发热及全身压痛，类似憩室脓肿。
在临床中，异物摄入常见于儿童、有智力障碍、精神疾病或酗酒的成年人以及佩戴假牙的老年患者。然而，吞入牙刷的情况很罕见，仅有约40例报道。
异物导致的肠道穿孔可能类似急性阑尾炎，在鉴别诊断时应予以考虑。临床上，患者常常记不起吞入过异物，这使得临床诊断更具挑战性，正确诊断也常常延迟。一些影像学检查，如小肠造影、超声检查和计算机断层扫描，可能会得出正确诊断，但在大多数患者中，直到进行手术干预才得以确诊。
