CASE

IN WHICH

A PLATE WITH ARTIFICIAL TEETH

WAS

SWALLOWED, DETECTED IN THE STOMACH, AND EXTRACTED.

BY

LOUIS STROMEYER LITTLE,

LATE ASSISTANT-SURGEON TO THE LONDON HOSPITAL.

COMMUNICATED BY

T. B. CURLING, F.R.S.

Received December 9th, 1869.-Read February 8th, 1870.

H. K—, a woman, æt. 40, was admitted into the London Hospital on the 2nd of January, 1864. Two days before her admission the patient, whilst in an epileptic fit, swallowed a gold plate with five artificial teeth attached to it, and with three sharp hooks to fix the plate to the natural teeth. On recovering from the fit she felt a good deal of pain when attempting to swallow, but succeeded in eating a considerable quantity of new bread, as she was recommended to do. She shortly afterwards vomited up the bread, and had not been able to keep down any food, either solid or liquid, since

the accident; she therefore came to the hospital. The house surgeon easily passed a probang into the stomach, and felt and heard it strike against a hard body. An emetic was given without result. The next morning I saw the patient and sounded the stomach with an ivory-tipped whalebone probang, and at once detected a metallic or hard body. I then introduced the coin-catcher, a whalebone probang with a split ring opened out so as to form a hook at its end, and after several attempts drew up with very little resistance as far as the pharynx, what proved to be the plate with the teeth attached. The plate could now be felt with the tip of the finger when introduced as far as possible, but every attempt to bring it further without force failed. Various curved forceps were tried, but ineffectually, as they slipped off the smooth surface which seemed uppermost. The plate was moved a little with each attempt, but was then drawn down again and impacted in the same place. The patient now became much distressed in her breathing, the plate probably pressing on and fixing the larynx, so that it was necessary to move the plate either upwards or downwards. I therefore again introduced the coin-catcher, passed the plate, and with a little force removed it.

The patient spat up some frothy mucus, tinged with blood. She was much relieved when the operation was over, and pleased at its result. The plate was much bent, probably by the forceps, and reduced in diameter, so that it was at last the more easily extracted.

She was ordered ice to suck, and to take twenty drops of laudanum.

January 4th. She complained that her throat was very sore, and that she could scarcely swallow. There were no signs of local or general ailment: The next day she could swallow fluids with care, but said she brought up a great deal of phlegm. During the following week she complained of a lump in her throat, which was referred to about the level of the thyroid cartilage on the left side, but by the 20th inst. she could eat quite well. The foreign body consisted of a gold plate, curved in form so as to fit the front of the jaw,

and made to sustain five artificial teeth, three incisors, a canine and a bicuspid. It measured one inch and three quarters in its greatest length, and an inch and a quarter in its greatest width.

At one extremity there were two projecting hooks for attachment to the adjoining teeth, one of which was very sharp and prominent; the other was curved, and also sharp pointed. At the opposite extremity there was only one short curved hook.

When I was called to this case, the question arose whether I ought to attempt to remove the teeth or not. Of their presence in the stomach there could be no doubt. They had been there three days without passing any further, and they caused so much irritation as to prevent the retention of food in the stomach. During this period, notwithstanding frequent vomiting and the action of an emetic, the teeth had not been removed upwards. It seemed, therefore, probable that they would remain in the stomach, and not only interfere with its functions but also injure its walls. From these considerations the removal of the foreign body, if it could be effected without force, seemed desirable; and as the teeth had already passed the cardiac orifice of the stomach, they would in all probability re-pass through the oesophagus with ease. After several attempts at removal, it was clear, on withdrawing the hooked probang, that it had caught hold of something which followed it so readily that there seemed no reason to stop, and when once the teeth reached the

96 EXTRACTION OF A FOREIGN BODY FROM THE STOMACH.

neck the chief reason for anxiety was at an end: viz., that of their becoming impacted in the oesophagus where they could not be got at from without.

Mr. Pollock's experiments* go to show that even a small plate with sharp points will not pass beyond the stomach, and this case is confirmatory of his experiments. In a similar case, then, the surgeon, when satisfied that the teeth are in the stomach and that they will not in all probability be removed by nature, should attempt their extraction with the assurance that if they will pass the cardiac orifice of the stomach without force, they will pass through the whole œsophagus.

* Vide 'Lancet,' April 10, 1869, p. 490.