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 50-year-old male presented at the General Surgery Polyclinic due to increased complaints of swelling and intermittent pain in the neck which had been ongoing for 6 years. On the neck ultrasound imaging, heterogeneous nodules were observed in the parenchyma of 27 × 19 mm in the right lobe and 20 × 16 mm in the left lobe and central anechoic cystic nodules 40 × 18 mm at the isthmus level extending towards the lumen. Thyroid function tests were normal and the patient was diagnosed with multinodular goitre. The patient had no comorbid disease and after premedication was admitted to the operating room for elective surgery. Monitorization was applied on the operating table: TA: 130/85 mmHg, pulse: 75 bpm, SpO2: 99%. Sedation was administered by 2 mg midazolam, then anaesthesia induction was made with 2-3 mg/kg propofol, 100 mcg fentanyl, and 0.6 mg/kg rocuronium. After mask ventilation for 3-5 mins, the patient was intubated with no problems. No hemodynamic or respiratory problems were experienced in the intraoperative period. The surgery lasted 1 hr and 45 mins, after which the patient was awakened with no problems and was transferred to the postoperative anaesthesia care unit (PACU). When the patient was fully awake, he was experiencing chest pain and complained that dentures were not in place in his mouth, so a posterior-anterior pulmonary radiograph was taken and a standing direct abdominal radiograph. The dentures were observed in the stomach (). In the history taken from the patient, it was seen that when going to the operating room, partial fixed dentures were in place, and he stated they were in his mouth until reaching the operating room. The emergency gastroenterologist was consulted, and the patient was evaluated but as he had already eaten food, endoscopy procedures were postponed until the following day. In the upper gastrointestinal endoscopy applied the following day, despite having passed the ligament of Treitz, the dentures could not be visualized. On the standing direct abdominal radiograph, the dentures were seen to be in the jejunum (). The abdominal examination was comfortable for the patient, so it was decided to continue medical follow-up. A standing direct abdominal radiograph was taken daily (), and on the radiograph taken on the 5th day, the dentures could not be seen (). The patient was questioned. The dentures had been expelled during bowel evacuation, but the patient did not recall anything other than a slight pain during evacuation.