Swallowed Toothbrush in a Bulimic Adolescent

A 16-year-old girl of normal weight for height (body mass index, 21) was evaluated for a 6-month history of binge-purge cycles and amenorrhea. She met the diagnostic criteria for bulimia nervosa and began treatment that involved a multidisciplinary team. During the second month of therapy, the patient presented to the emergency department after she accidentally swallowed a toothbrush while trying to induce vomiting with the brush’s handle. Adela Spalter, MD, of Buenos Aires writes that anteroposterior and lateral chest films showed 4 parallel rows of short metallic densities (A and B), which represented the metallic plates connected to the bristles. The head of the toothbrush was in the cardiac part of the stomach. The location of the toothbrush handle could not be established. The patient was given general anesthesia; an esophagoscopy with a rigid fibroscopic instrument was performed, and the toothbrush was successfully removed. In bulimic patients, repetitive vomiting may cause swelling of the salivary glands, hoarseness, dental erosion, and throat irritation or lacerations. Self-induced vomiting is often concealed and thus difficult to detect; however, it may result in injury, such as abrasions on the dorsum of the hand. Most reports of accidental toothbrush ingestion have involved adolescent girls who had an eating disorder.1-4 Many complications secondary to bulimia nervosa are related to poor eating habits, malnutrition, and binge-purge cycles. The accidental ingestion of a toothbrush or other foreign body is a rare but dangerous complication. Moreover, patients who use an object to induce vomiting are at risk for other serious health problems, such as pressure necrosis, gastritis, and esophageal or gastric perforation. This patient recovered uneventfully; she ate 2 hours after the toothbrush was removed. Oral fluoxetine (40 mg/d) was prescribed: the patient’s binge-purge cycles promptly stopped, menses restarted the following month, and she maintained a normal weight.