Silent fractured denture ingestion resulting in sigmoid colon perforation: A case report

Introduction

Foreign body ingestion is a common emergency presentation, predominantly affecting pediatric and elderly populations, with potential for significant complications. ¹

Removable dentures may impact narrow gastrointestinal segments, leading to ischemia, necrosis, and perforation. Although <1% of ingested foreign bodies result in perforation, sharp objects, such as denture clasps, carry a much higher risk, reaching 15%–35%.^2–4

Foreign bodies pass spontaneously in 80%–90% of cases; 10%–20% require endoscopic removal, and <1% need surgery, typically in late or perforation cases. ⁵

This rare case describes a 78-year-old woman who developed generalized peritonitis and pneumoperitoneum following silent ingestion of a fractured denture. Two days after her denture broke and she attempted to glue the pieces, she later presented with a missing portion of the denture and acute abdomen. Emergency exploratory laparotomy revealed a perforation of the sigmoid colon with the fractured denture protruding through the perforation, necessitating extraction and a Hartmann procedure.

This case has been reported in accordance with the CARE guidelines (Supplemental Material). ⁶

Case presentation

A 78-year-old female, known hypertensive on regular antihypertensive medications, presented with a 1-week history of abdominal pain. The pain was of sudden onset, colicky in nature, and not related to meals. It was associated with progressive abdominal distension, bloating, nausea (without vomiting), loss of appetite, and constipation for 5 days with no passage of flatus. She had been using lactulose and underwent two enemas with minimal relief. She reported hematochezia 2 days prior to presentation. There was no history of fever, urinary symptoms, dizziness, palpitations, prior abdominal surgeries, or inflammatory bowel disease.

On further inquiry, she reported that 5 days prior to the onset of symptoms, her removable denture had broken. She attempted to repair it with glue and unknowingly swallowed a missing fragment. She continued using the denture until she noticed the missing portion, after which her abdominal symptoms began.

On examination, she was tachycardic. The abdomen was markedly distended and tender on palpation, with rebound tenderness and guarding suggestive of peritonitis. Bowel sounds were present. Other systemic examinations were unremarkable.

Laboratory investigations revealed a normal white blood cell count (5.74 × 10⁹/L), anemia (hemoglobin 9.7 g/dL; hematocrit 30.7%), normal platelet count (268 × 10⁹/L), normal electrolytes, elevated creatinine (110.96 µmol/L) with an estimated GFR of 43.6 mL/min/1.73 m², markedly elevated C-reactive protein (506 mg/L), and elevated procalcitonin (80 ng/mL).

Contrast-enhanced abdominal computed tomography (CT) scan demonstrated findings suggestive of sigmoid colon perforation likely secondary to a foreign body, with mild pneumoperitoneum and peritoneal fluid collection. Segmental bowel wall thickening was noted, consistent with inflammation (Figure 1).

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Figure 1.

(a) Axial contrast-enhanced CT scan of the abdomen demonstrating a hyperdense foreign body within the sigmoid colon (arrow) with adjacent extraluminal air pockets suggestive of bowel perforation. (b) Three-dimensional reconstructed CT image with the white arrow indicating the ingested foreign body.

The patient was kept nil per os and resuscitated with intravenous fluids, broad-spectrum intravenous antibiotics were initiated along with analgesia. Strict input–output monitoring was commenced, and informed consent was obtained for emergency exploratory laparotomy.

She underwent emergency laparotomy under general anesthesia. Intraoperative findings included a gush of purulent peritoneal fluid with fecal contamination, thickened omentum, fibrin deposits over bowel walls, and widespread inflammatory changes involving small bowel loops and most of the descending and sigmoid colon. A denture fragment with a metallic component was identified within the sigmoid colon lumen, with the metallic edge perforating the bowel wall and causing leakage of intestinal contents into the peritoneal cavity.

The metallic fragment was retrieved. The sigmoid colon was clamped and divided at the sigmoid-rectal junction using a linear stapler, forming a Hartmann’s pouch. The perforated segment was resected, and an end colostomy was fashioned in a tension-free manner with confirmed vascularity. The abdomen was thoroughly irrigated with warm saline, drains were placed, and the abdomen was closed after achieving hemostasis. Hartmann’s procedure was completed (Figure 2).

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Figure 2.

(a) Intraoperative image showing the sharp metallic edge of the denture fragment perforating and protruding through the sigmoid colon wall. (b) Extracted fractured denture segment following surgical removal.

The patient was admitted to the high dependency unit postoperatively. She received IV antibiotics, analgesia, fluids, and mechanical thromboprophylaxis with close monitoring. Her recovery was uneventful with steady improvement. She is now discharged with a plan for reversal colostomy after 3 months.

Discussion

Dentures are among the most swallowed foreign objects in adults, accounting for roughly 4%–18% of incidents. ⁷

Along with items like fish or chicken bones, batteries, toothpicks, and coins, they frequently contribute to gastrointestinal foreign body cases and can result in serious complications such as obstruction, perforation, or bleeding if not identified and treated promptly. ⁸

Denture use is a well-recognized risk factor for foreign body ingestion, as reduced palatal sensation and poor prosthesis fit may predispose to accidental swallowing. ⁹

Studies by Lau et al. and Neustein and Beicke have identified several risk factors for denture ingestion among denture wearers, including advanced age, ill-fitting or damaged prostheses, facial trauma, psychoneurological disorders, alcohol intoxication, drug overdose, general anesthesia, and diabetes.^10,11

In our case, the patient was an older woman with broken dentures, aligning with the key risk factors highlighted in previous reports.

Ten-year literature review by Daniels et al. found that ingestion of dental prostheses can cause serious complications, particularly in elderly patients. The most frequent complication was hollow viscus perforation (50%), followed by fistula formation (22%), bowel obstruction (14%), and, in rare cases, mortality due to aspiration or sepsis (2.4%). ¹²

Our patient developed a sigmoid colon perforation, aligning with the most frequently documented complication in the existing literature.

Denture impaction most commonly occurs in the esophagus, with rare involvement of the small bowel at the terminal ileum. Colonic impaction is uncommon due to its wider lumen but, when present, is often linked to stenosis or malignancy and may cause perforation. Sharp foreign bodies typically perforate at narrow or angulated sites such as the duodenojejunal junction, ileocecal junction, colonic flexures, and diverticula.^13–15

Our case is notable for perforation of the sigmoid colon, an uncommon site for denture impaction, occurring without any underlying malignancy as confirmed by histopathological analysis. This emphasizes both the rare location and the absence of typical predisposing colonic pathology.

Nandu et al., Fang et al., and Khadda et al. all described patients presenting with abdominal pain and signs of peritonism after denture ingestion, which led to colonic perforation, consistent with the findings in our patient.^2,16,17

In a review of 33 surgically treated perforations from ingested foreign bodies, only 9.1% were diagnosed preoperatively, reflecting the difficulty of detection due to nonspecific symptoms, radiolucent or small objects, delayed presentation, hidden anatomical locations, and patients’ poor recall of ingestion. ¹⁸

Accurate imaging is essential in suspected gastrointestinal foreign body ingestion; European Society of Gastrointestinal Endoscopy guidelines recommend CT with 3D reconstruction as the modality of choice due to its high sensitivity for localization and complication assessment, while plain radiography is limited by the radiolucency of prosthetic materials and MRI offers minimal additional benefit in acute settings.^7,19,20

In our case, preoperative CT accurately detected the foreign body with the features as described, demonstrated sigmoid colon perforation, and clearly defined its location, thus enabling an appropriate surgical strategy and planning.

Peritonitis from foreign body ingestion requires urgent surgery. While exploratory laparotomy remains standard in unstable or complex cases, laparoscopic or laparoscopic-assisted approaches have been reported. Management usually involves bowel resection, with primary repair in select patients; generalized sigmoid colonic perforation mandates emergency intervention, often via a Hartmann procedure when primary anastomosis is not feasible.^8,21

Our patient underwent a staged Hartmann procedure for emergent management of sepsis and colon perforation, including laparotomy, foreign body removal, resection of necrotic bowel, proximal colostomy, and distal stump closure.

This approach-controlled infection and minimized operative risk. The patient is planned for a staged Hartmann reversal after 3 months to restore bowel continuity, reduce postoperative trauma, and achieve favorable outcomes, as successfully reported by Fang et al. ²

Mabrouk et al. emphasized that preventing denture ingestion and thereby minimizing the risk of associated complications requires a multidisciplinary approach involving dental, anesthesia, and surgical teams, with careful pre-procedural risk assessment. Dentists ensure proper prosthesis fit and provide patient education, while anesthesiologists maintain vigilant airway monitoring, particularly in elderly or cognitively impaired individuals. ⁹

Clinicians should maintain suspicion for foreign body ingestion in elderly denture users with unexplained abdominal symptoms, even without a clear history. CT is essential for accurate diagnosis. Early intervention prevents complications such as perforation and sepsis.

Conclusion

Denture ingestion in adults, particularly the elderly, can lead to serious complications such as bowel perforation and peritonitis. Early recognition, accurate imaging, and timely individualized management often surgical are essential for favorable outcomes. Preventive measures, including proper denture fit and patient education, alongside multidisciplinary care, are crucial to reduce risk and optimize recovery.

Supplemental Material