Radiology Case Reports 17 (2022) 4928–4931

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/radcr

Case Report

Accidental ingestion of an endodontic file: A case

report and literary review ✩

Ariana R. Tagliaferri, MD∗, Gabriel Melki, MD, Crystal Feghali, BS, Yana Cavanagh, MD
Department of Gastroenterology, St. Joseph’s University Medical Center, Paterson, NJ 07470, USA

a r t i c l e i n f o a b s t r a c t

Article history: Ingestion and aspiration can be accidental or intentional events in both adults and children.
Received 9 September 2022 Approximately 1500 people in the United States die from ingestion of foreign bodies annu-
Revised 17 September 2022 ally. Patients with cognitive disabilities, neurological disorders, elderly age or incarcerated
Accepted 21 September 2022 patients carry the highest risk of intentional and/or accidental ingestion of foreign objects.
Although uncommon, ingestion of foreign objects during dental procedures can be poten-
tially life-threatening and increased awareness is important. Sharp objects ingested from
Keywords: dental procedures can cause impaction, obstruction, hemorrhage, or perforation and may
Accidental ingestion need endoscopic or surgical intervention. Herein we report a case of a 22-year-old male, who
Endodontic file underwent routine dental cleaning and accidentally ingested an endodontic file, retrieved
Dental procedure from the ascending colon endoscopically without complications.
Endoscopy © 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
Endoscopic retrieval This is an open access article under the CC BY license
Gastroenterology (http://creativecommons.org/licenses/by/4.0/)

[1,3]. Additionally, patients taking opiates, anti-depressants or

Introduction other sedatives, alcohol abusers, and patients with neurolog-
ical disorders such as those with Parkinson’s disease, demen-
Ingestion and aspiration of foreign bodies have been well doc- tia, epilepsy or strokes are also at an increased risk [1].
umented [1–3]. In general, ingestion is more common than After ingestion there is a 12:1 chance that the object will
aspiration, although occurs more frequently in the pediatric pass over the respiratory tract and enter the digestive tract
population [1,2]. Usually incidents of ingestion or aspiration [2]. A retrospective, cross-sectional study identified variables
occur in children younger than 3 years old with a male to fe- that affected visualization of foreign bodies after ingestion
male ratio of 1.2:1 [1]. Between accidental and intentional inci- and demonstrated that of 168 endoscopies, 52.4% of objects
dents, approximately 1,500 children and adults die each year could be retrieved from the mouth at time of presentation [4].
following ingestion of foreign bodies in the United States [1]. Of these, elderly patients were more likely to have the foreign
Patients with cognitive disabilities or motor deficits, such as bodies removed from the mouth, and objects that were visible
those who are elderly, physically disabled or mentally chal- on imaging were visualized and retrieved endoscopically [4].
lenged have a higher risk of ingestion and aspiration events As such, the majority of foreign objects can be managed non-

✩
Competing Interests: Authors have nothing to disclose. No financial support was obtained for this report. No conflicts of interest to
report. Consent was obtained prior to writing this manuscript.
∗
Corresponding author.
E-mail address: r_tagliafea@sjhmc.org (A.R. Tagliaferri).
https://doi.org/10.1016/j.radcr.2022.09.071
1930-0433/© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the
CC BY license (http://creativecommons.org/licenses/by/4.0/)
 Radiology Case Reports 17 (2022) 4928–4931 4929

surgically, however up to 1% may require surgical interven-

tions [2]. The majority of ingested foreign objects include bo-
luses of food, bones, seeds, beans, batteries and coins [1,4]. It is
a rare, but documented and serious adverse event for acciden-
tal ingestion of dental instruments during dental procedures
[2,3]. Although the true incidence of this is unknown, previ-
ous studies have estimated the incidence to be from 0.00012%
to 0.004% [2]. Many dental instruments and appliances have
been documented, such as dental burs, endodontic files, rub-
ber dam clamps, dental mirrors, implant instruments, and
barbed broaches [3]. Although it is rare, complications can be
serious and possibly fatal and thus awareness of these adverse
events and how to manage them are crucial.
Herein we report a case of a 22-year-old male, who under-
went routine dental cleaning and accidentally ingested an en-
dodontic file, retrieved from the ascending colon endoscopi-
cally without complications.

Fig. 1 – X-ray of abdomen demonstrating foreign object in

the gastric antrum. Initial X-ray of the kidneys, ureters and
bladder revealed a 4 mm linear radiopaque foreign body
Case report overlying the midline of the upper abdomen. Arrow
indicates foreign body likely in the gastric antrum. No free
A 22-year-old male with past medical history of obesity pre- air or obstruction identified.
sented to the Emergency Department (ED) after accidently
swallowing a dental file during a procedure. The patient re-
ported minimal epigastric pain and he denied nausea, vom-
iting, fever or chills. He was able to swallow his saliva with-
out difficulty, denied hoarseness and was not in respiratory
distress. On physical exam he was afebrile and normoten-
sive, saturating 99% on ambient air. He had normoactive
bowel sounds and had mild epigastric tenderness. Laboratory
studies including a comprehensive metabolic panel, complete
blood count and lipase were within normal limits. X - ray films
of the neck, chest and abdomen were performed revealing a
4 mm linear radiopaque foreign body identified overlying the
midline of the upper abdomen likely in the gastric antrum
(Fig. 1). Since the sharp end of the dental file was in the gas-
tric antrum, a decision was made to pursue an enteroscopy
for foreign body retrieval. The enteroscopy revealed a normal
esophagus, gastric, duodenal and jejunal mucosa, and the for-
eign body was not found. The patient was kept in the hos-
pital overnight for serial abdominal exams and repeat imag-
ing approximately 6 hours following the procedure. The X-ray Fig. 2 – X-ray of abdomen demonstrating foreign object in
showed a previously identified linear radiopaque foreign body left mid-abdomen. A repeat X-ray of the kidneys, ureters
now overlying bowel loops in the left mid-abdomen (Fig. 2). and bladder revealed a linear radiopaque foreign body
The exact location however could not be determined from overlying bowel loops on the left side of the mid-abdomen
this image alone. The following morning the patient reported (arrow). The exact location could not be identified. No free
he was no longer in abdominal pain and physical exam did air noted on film.
not reveal tenderness. He had repeat imaging revealing a ra-
diopaque foreign body in the right lower abdomen (Figs. 3 and
4). The patient was started on a clear liquid diet, given a bowel
prep and underwent a colonoscopy that afternoon. The for- Discussion
eign body was retrieved from the ascending colon. The sharp
end was piercing the mucosa, superficially. The removal of the Although accidental ingestion is more common in children
dental file was accomplished using a Roth net and removed overall, the second most common cause of accidental inges-
with rat tooth forceps. This was extracted into the rectum and tion in adults is from dental procedures [1]. In a span of 10
was manually removed to minimize trauma in the anal canal years, 36 or more incidents have been reported [1]. A PubMed
(Figs. 5 and 6). The patient tolerated the procedure well with database search from 1983 to 2016 revealed that smaller ob-
no complaints or complications. jects, such as archwire fragments or brackets comprised the
4930 Radiology Case Reports 17 (2022) 4928–4931

Fig. 5 – Colonoscopy images from the ascending colon. The

colonic mucosa was normal. Arrow indicates a foreign body
was found in the ascending colon. Removal was
Fig. 3 – X-ray of abdomen demonstrating partial small accomplished using a Roth net and rat root forceps. This
bowel obstruction. A repeat X-ray of the kidneys, ureters was extracted into the rectum and manually removed.
and bladder revealed mildly dilated small bowel loops
representative of ileus or partial small bowel obstruction.
Arrow indicates a radiopaque foreign body in the right
lower abdomen without evidence of mass effect. There is
no evidence of free air. Measurement approximately 38
mm.

Fig. 6 – Dental file after extraction from the rectum. The

dental file after removal from the rectum.

majority of cases, while only 4 accidents involved larger ob-

Fig. 4 – X-ray of abdomen demonstrating migrating foreign
jects such as a fractured Twin block appliance, intact quadhe-
object. A repeat X-ray of the kidneys, ureters and bladder
lix or 3 cm-long Kobayashi ligature [1]. Other common items
revealed redemonstration of a linear radiopaque foreign
which have been reported in current literature include sec-
body in the right mid-abdomen, migrating likely into the
ond molar buccal tubes, trans-palatal arches, impression ma-
ascending colon (arrow).
terials, toothpicks, files, burs, clamps, removable prostheses,
retainers, dental implant screw drivers, mirror heads and ex-
 Radiology Case Reports 17 (2022) 4928–4931 4931

tracted teeth [1]. In certain patients with neurological dis-

eases, the incidence may be higher due to reduced gag re-
Author contributions
flex and decreased metabolism of sedation [3]. Patients who
intentionally ingest foreign objects primarily ingest metallic Tagliaferri, A.R., wrote the manuscript and performed the lit-
items, and are often prisoners or psychologically disabled per- erary review. Melki, G., Feghali, C., and Cavanagh. Y assisted
sons [5]. Comparatively, accidental ingestion of food or dental with the collection of the patient’s data and reviewed and
objects is common in other demographics [5]. A retrospective edited the final manuscript. All authors consent to this publi-
analysis demonstrated that metallic items are usually located cation.
in the stomach in 64% of cases, whereas food, bones or dental
objects are found in the esophagus in 87.5% of cases [5]. This
study determined that those who intentionally ingest foreign
Patient consent
bodies had a longer duration of impaction and thus had less
success with endoscopic or surgical retrieval [5]. Early iden-
tification and intervention are imperative in this population Consent was obtained for the purpose of this paper.
[5].
Most items pass spontaneously within 7-10 days; however,
management and possible complications are contingent on
Acknowledgments
the size and shape of the object [2,4]. Life threatening compli-
cations include impaction, ulceration of the mucosa, obstruc-
We would like to thank the patient for allowing us to share
tion, abscess formation, hemorrhaging or fistula formation
this case with our colleagues. We would also like to thank Dr.
[1,2,5]. Foreign objects less than 5 cm are likely to pass without
Abraham for their help in caring for and managing the patient
complications; however, the pylorus, appendix, sigmoid colon
in the hospital.
and anal canal are high-risk sites for impaction and perfora-
tion [1]. Sharp objects, such as endodontic files have a higher
risk of causing these complications, as they pass the curves
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Conclusion

Ingestion of foreign objects is a rare but potentially life-

threatening event that can be minimized through preventa-
tive measures during dental procedures.