A Crown of Gold.

CASE REPORT

An 82-year-old man presented after accidentally swallowing his gold tooth crown. He was asymptomatic, and an abdominal x-ray (XR) revealed a metallic object consistent with a dental crown in the area of the ascending colon. After 3 weeks of observation, the crown remained in unchanged position on XR, and he was referred for endoscopic removal. The patient completed a vigorous bowel prep before colonoscopy in the hopes this would facilitate passage; however, the crown remained in place on XR the morning of the procedure (Figure 1). Colonoscopy demonstrated a gold tooth crown lodged in the appendiceal orifice (Figure 2), which was removed with forceps (Figure 3). On removal, the appendiceal orifice did not have any evidence of tissue disruption or inflammation. The crown was removed from the gastrointestinal tract using an endoscopic Roth Net (Figure 4).

Figure 1.

X-ray of the abdomen demonstrating square-shaped lucency in the right lower hemiabdomen representing the metallic tooth crown.

Figure 2.

View of the cecum during colonoscopy showing gold tooth crown lodged in the appendiceal orifice.

Figure 3.

Colonoscopic image of gold tooth removed from the appendiceal orifice using forceps.

Figure 4.

Colonoscopic image of gold tooth being retrieved using endoscopic Roth Net.

When swallowed, either incidentally or during dental procedures, tooth crowns typically pass spontaneously through the stool after several days to weeks.[1,2] Although endoscopic retrieval of asymptomatic ingested foreign bodies in the small bowel or colon is generally not recommended, they have been occasionally implicated in the development of complications such as impaction, perforation, or obstruction.[3] For instance, there have been rare case reports of swallowed crowns becoming lodged in the appendiceal orifice and causing acute appendicitis.[4] Suspected foreign bodies in the appendiceal orifice should be followed by serial abdominal radiographs. If the anatomical position of the object seems not to change and remains in the right lower abdominal quadrant after several weeks, an attempt at colonoscopic removal is indicated.[5] This case illustrates the successful endoscopic retrieval of an ingested metallic tooth crown that failed to pass spontaneously after 1 month.

DISCLOSURES

Author contributions: All authors collected and/or interpreted data, drafted the manuscript, and approved the final submitted draft. D. Francis planned and conducted the study and is the article guarantor.

Financial disclosure: None to report.

Previous presentations: This case was presented at the American College of Gastroenterology Annual Scientific Meeting; October 22-27, 2021; Las Vegas, Nevada.

Informed consent was obtained for this case report.