A 47-year-old Iranian woman presented to our hospital with the chief complaint of pain in the abdomen (mostly in the epigastric area) for the previous 2 days, associated with recurrent vomiting, nausea, and anorexia. Her complaints had started 2 hours after the accidental ingestion of a dental prosthesis about 2 days before admission (Fig. ). The patient has a known history of asthma and migraine headache and a history of wearing artificial dentures. At the time of admission, she was conscious and oriented to time, place, and person. Her pulse rate was 90 beats per minute, and her blood pressure was 100/60 mmHg. Her physical examination revealed severe epigastric and mild right upper quadrant abdominal tenderness.\nA radiograph showed no free gas under the right dome of the diaphragm and no air-fluid level (Fig. ). Ultrasonography revealed that there was no free fluid in the peritoneal cavity. Spiral abdominal computed tomography (CT) with oral and intravenous contrast revealed duodenal wall thickness in D2–4, peripheral mesenteric fat edema, hematoma in D1–3, air in the intestinal wall, pneumoretroperitoneum, laceration in D1–2 and a part of D3, and microperforations in D2–3. Because of the hematoma, narrowing in the primary and middle parts of the duodenum was seen (Figs. and ).\nVideo endoscopic findings were an old healed linear ulcer scar in the bulb of the duodenum, and also a swallowed lodged denture was seen in D2–3 after a papilla, which left a laceration behind. An attempt to capture the foreign body was not possible because of difficulty in the procedure and the chance of induced laceration, so a gastroenterologist recommended surgical evacuation of the denture. Laboratory investigation results are shown in Table .\nAfter preparation of the operation site, a midline laparotomy was performed. The stomach and small bowel were examined carefully for any perforation, but no pathology was revealed; however, a foreign body was palpable between the second and the third portions of the duodenum inside the lumen, so duodenal kocherization was performed to explore the duodenum for any perforations. There was no gross perforation in the duodenal wall, so the foreign body was pushed through the lumen to pass back to the stomach from the pylorus. A gastrostomy was performed, and the foreign body was removed and identified as an artificial denture (Fig. ). Then the stomach was repaired in two layers. Washing with normal saline was done, and an abdominal drain was placed at the duodenal site of kocherization. The patient recovered well postoperatively and was discharged on the ninth day of her total hospitalization in good condition.
A 16-year-old girl presented to the emergency room of pediatrics department in our hospital with complaints of abdominal pain, nausea and vomiting. Physical examination revealed tenderness on the right upper quadrant of the abdomen. Blood analysis showed increased white blood count (15, 91/μl) with left shift, an erythrocyte sedimentation rate of 78 mm/h, and C-reactive protein (CRP) 279 mg/l. The other laboratory examinations revealed increased levels of Aspartate transaminase (AST): 57 U/L, Alanine aminotransferase (ALT): 104.91 U/L, Lactate dehydrogenase (LDH): 599 U/L, and Alcalene phosphatase (ALP): 575 U/L.\nOn abdominal X-ray, a metallic lineer radio opaque image compatible with a foreign body was seen on right hepatic lobe localization (). Abdominal ultrasonography (US) examination revealed a 3cm long lineer echogeneity in segment 5 surrounded by an irregularly contoured heterogeneous hyper echoic area of 10×7cm in size (), and made us think about migration of a swallowed foreign body into the liver accompanied by an abscess formation. The patient was unaware of having swallowed any foreign body, but when we insisted on any possibility of such a condition, she remembered that she could have swallowed a sewing needle approximately a month ago while drinking water. She told that she saw a number of sewing needles in the water glass which she noticed after drinking some water. On further examination with abdominal computed tomography (CT), the metallic foreign body and surrounding inflammation were better demonstrated (Figs. , ).\nThe patient underwent surgical operation for the excision of the foreign body, but it could not be reached, and it was failed to get the foreign body due to patient's condition change during the operation. The patient went home with antibiotherapy for the surrounding inflammation. Two and a half months later the patient presented again with abdominal pain, and control CT examination demonstrated the migration of the foreign body inferomedially near to the gallbladder (Figs. , ). The surrounding inflammatory changes were disappeared. On reoperation with open abdominal surgery, the sewing needle was found easily due to its migration nearby the gallbladder, and it was removed from the liver. The patient recovered successfully after the operation.