the majority of swallowed indigestible foreign bodies pass through the gastrointestinal tract without complications [ 1 , 2 , 3 , 4 ] . however , there are three physiological narrowings involving the pylorus , duodenal c - loop and ileocecal valve . foreign bodies
longer than 10 cm , such as a toothbrush , can not negotiate the duodenal c - loop due to its fixed retroperitoneal position .
these objects should be endoscopically removed as soon as possible to avoid pressure necrosis and gastrointestinal perforation [ 5 , 6 , 7 ] . if endoscopic removal fails or there is evidence of obstruction or perforation , laparoscopic gastrotomy should be performed .
an 18-year - old caucasian woman with no previous history of related medical problems was admitted to the department of internal medicine , division of gastroenterology , clinical hospital split because she had accidentally swallowed a toothbrush .
the patient admitted she had been using the toothbrush to induce emesis . on presentation , 2 h after ingestion , she was asymptomatic and her vital signs were within normal limits .
a plain abdominal x - ray study confirmed the presence of the foreign body in the left upper abdominal quadrant ( fig .
informed written consent for upper gastrointestinal endoscopy was obtained from the patient and her parents .
esophagogastroduodenoscopy revealed the toothbrush in the stomach with its head positioned against the gastric fundus .
the extracted toothbrush was 20 cm long . repeated upper gastrointestinal endoscopy was performed 4 h later and showed no evidence of mucosal lesion to the stomach or the esophagus .
the patient was discharged home in excellent clinical condition after being observed for 6 hours .
foreign bodies in the stomach will pass uneventfully through the gastrointestinal tract in 8090% of cases [ 1 , 2 , 3 ] .
however , foreign objects longer than 10 cm , such as a toothbrush , can not negotiate the duodenal c - loop due to its fixed retroperitoneal position .
in such cases , these objects should be removed as soon as possible to avoid pressure necrosis and gastric perforation [ 2 , 3 , 4 , 5 ] .
removal of long foreign bodies from the stomach is influenced by the patient 's clinical condition and technical abilities of the endoscopist [ 2 , 3 , 4 , 5 ] .
if endoscopic removal fails or there is evidence of obstruction or perforation , surgical gastrotomy should be performed .
we had no need for conscious sedation since the patient was actively participating during the procedure .
special attention has to be paid during the extraction of the toothbrush to its alongside alignment with the esophagus .
otherwise , this most critical and demanding part of the extraction procedure may easily result in mucosal damage or foreign body impaction .
the second important phase of the extraction procedure is when the foreign body reaches the oropharynx .
the patient has to extend his head backwards and the endoscopist has to reach for the toothbrush with his hand and pull it out .
this case report describes a rare case in whom a toothbrush was safely extracted from the stomach endoscopically by snare extraction .
the procedure is brief , does not require conscious sedation , and the patient can be discharged from hospital after a few hours .
early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality . in cases when endoscopic removal fails
 most ingested foreign bodies will pass uneventfully through the gastrointestinal tract . nevertheless , long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction , perforation and bleeding . moreover , there has been no case of spontaneous passage of a toothbrush reported . 
 therefore , the prompt removal of such ingested foreign objects is recommended before complications develop . 
 this case report describes a case of an 18-year - old woman who accidentally swallowed her toothbrush . 
 the toothbrush was successfully removed via flexible endoscopy using a polypectomy snare . 
 a swallowed toothbrush is a special clinical challenge . 
 early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality . in cases when endoscopic removal fails 
 , a laparoscopic surgical approach may be an alternative . 
Introduction
Case Report
Discussion
Conclusion
Disclosure Statement