An uncommon complication of dental bridge ingestion: Dual obstructive uropathy and bowel obstruction - Case report

Foreign body ingestion is a significant clinical concern, particularly among elderly and psychiatric patients, often leading to complications such as intestinal obstruction. In this article, we present an intriguing case of dual intestinal and urinary obstruction caused by the ingestion of a dental bridge in a patient with Bricker urinary diversion. Through this rare case, we aim to explore the diagnostic and therapeutic challenges associated with such incidents, supported by a comprehensive review of the literature.

A 52-year-old edentulous male with a history of bipolar disorder and a cystoprostatectomy with Bricker-type urinary diversion presented to the emergency department with a one-week history of subumbilical abdominal pain, vomiting, abdominal bloating and anuria. Physical examination revealed fever (38.5 °C), abdominal distension, localized guarding in the right iliac fossa, and a non-functional urostomy. Laboratory investigations demonstrated significant inflammatory markers accompanied by acute renal insufficiency. Abdominal computed tomography (CT) imaging identified a mechanical small bowel obstruction caused by impacted dense fecal material, with proximal bowel dilation leading to extrinsic compression of the Bricker conduit, which showed wall thickening. Following brief resuscitation, the patient underwent an exploratory laparotomy. During the procedure, marked small bowel distension was observed (upstream of an intraluminal obstructive material) that was exerting extrinsic compression on the Bricker diversion loop. Catheterization of the Bricker loop decompressed the urinary system, while enterotomy allowed removal of a dental bridge. The postoperative recovery was uneventful.

The ingestion of dental prostheses carries life-threatening risks (obstruction, perforation), particularly in elderly patients or those with surgical histories (e.g., Bricker diversion). CT scanning is the gold standard for diagnosis. Management may range from simple observation to endoscopic extraction (which proves challenging in cases of small bowel impaction) or emergency surgery when severe complications are present. Multidisciplinary prevention strategies (including prosthesis checks and radiopaque markers) are crucial for at-risk populations.

The ingestion of foreign bodies, such as dentures, poses a significant risk of intestinal obstruction or perforation. Prompt diagnosis and immediate intervention are critical to ensuring favorable outcomes, particularly in vulnerable patient populations.