Abstract
We report two cases mis-swallowed dentures which were not sopntaneously excreted of even though the denture reached the large intestine. Typically mis-swallowed dentures or other foods of viscosity, such as rice cakes are spontaneously excreted within about 4 weeks after passing through the stomach in adults, and rarely necessiate removal by endoscopic or surgical therapy. In the present, 2 cases who were diagnosed by a local medical doctor immediately after the mis-swallowing, the denture reached the large intestine, as recoginzed by plain abdominal roentgenography and was not finally excreted: in 1 case it was endoscopically excreted, and in the other case it was surgically removed due to bridge-induced perforative peritonitis. To progress the observation and therapeutic approach for cases of mis-swallowed denture, the degree of advancement should be frequently confimed by roentgenography, and development of perforation is considered when stagnation or deviation of denture in the intesrinal tube are found at the site and abdominal pain and signs of peritoneal irritation develope. Therefore, abdominal findings of evidence of the signs of peritoneal irritation should be carefully examined. The definite diagnosis can be obtained by a free-air pattern on plain abdominal roentgenogram. When denture reaches the large intestine in advance, endoscopy should be carried out because perforation occurs more often in the large intestine than in the small intestine, and the removal of the denture is considered as a therapy to prevent perforation from occuring. For endoscopic removal, the denture should be transanally removed after confirmation of non-insertion of the tip of both bridges into the mucous membrane of the intestinal tube and by inducing the denture into sliding tube by using a wire. When the tip of the bridge is not confirmable by endoscopy or resistance in the traction of wire grasped denture occurs, the removal procedurt should be replaced by surgery due to the risk of inserting the bridge into mucous membrane of the intestinal tube. When closure of the perforative region due to the surgery is not performed for a long-term period, the perforative region should be spread to the direction of the intestina axis, and suture-closure to the transversal axis should be performed by wound-lip excision after removing the denture. In long-term progressed, cases. anastomotic closure should be carried out by excision of the tubular intestinal tube including the perforative regions.
