Endoscopy 2021; 53(12): E472-E473
DOI: 10.1055/a-1327-1339
E-Videos

Denture as an unexpected cause of obstructive jaundice

Alessandro Pezzoli
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
,
Viviana Cifalà
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
,
Elena Pizzo
2  Department of Applied Health Research, University College London, London, UK
,
Riccardo Solimando
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
,
Loredana Simone
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
,
Rosario Arena
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
,
Alberto Merighi
1  Department of Gastroenterology and GI Endoscopy, University Hospital Sant’Anna, Ferrara, Italy
› Author Affiliations
 

A 78-year-old woman who presented with jaundice and fever was referred from another hospital to our endoscopy unit. Her laboratory tests revealed a total bilirubin concentration of 11.7 µmol/L. Computed tomography (CT) scans revealed dilatation of the main biliary duct and the presence of a foreign body in the peripapillary area ([Fig. 1]). The appearance of the foreign body was suggestive of a denture, and the patient reported having involuntary ingested, 3 days previously, a denture that had been implanted many years ago. We performed an endoscopic retrograde cholangiopancreatography (ERCP), which revealed a protruding papilla with the appearance of an impacted stone. We started to perform a sphincterotomy using a precut needle-knife and completed it with a standard sphincterotome. After this, the denture was immediately expelled and allowed to pass into the duodenum ([Video 1]). In the following days, the patient’s total bilirubin level decreased and she was discharged home.

Zoom Image
Fig. 1 Computed tomography scans showing: a on sagittal view, dilatation of the main biliary duct and the presence of a foreign body in the peripapillary area; b on coronal view, the presence of a foreign body in the peripapillary area (arrow).

Video 1 Endoscopic retrograde cholangiopancreatography in a 78-year-old woman with jaundice and fever showing a protruding papilla and the expulsion of a recently ingested denture following sphincterotomy


Quality:

Foreign bodies may lead to a wide variety of complications, although the majority of foreign bodies will be passed spontaneously; among the elderly, the most common object is a dental prosthesis [1]

To the best of our knowledge, this is the only reported case of an impacted denture causing jaundice. We are unable to explain the possible way in which the denture could have got into the papilla, although such an occurrence is known to be possible because there are other reports of foreign bodies in the biliary tract, including toothpicks and surgical clips [2] [3] [4]. The speculated mechanism is reflux from the duodenum [5]. In this case, the sphincterotomy led to a fast resolution of the biliary obstruction and the patient was discharged a few days later. Because the majority of the ingested foreign bodies are unintentional and asymptomatic, the true incidence is difficult to evaluate, but we should nevertheless bear in mind the possibility of biliary obstruction being caused by small foreign bodies.

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Alessandro Pezzoli, MD
Dept of Gastroenterology and GI Endoscopy
University Hospital Sant’Anna
Via A. Moro n 8 Cona Ferrara
44100 Ferrara
Italy   

Publication History

Publication Date:
04 February 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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Zoom Image
Fig. 1 Computed tomography scans showing: a on sagittal view, dilatation of the main biliary duct and the presence of a foreign body in the peripapillary area; b on coronal view, the presence of a foreign body in the peripapillary area (arrow).