Fatal small bowel perforation caused by an impacted dental prosthesis in an elderly neurologically impaired woman

Foreign body ingestion is relatively common in clinical practice; however, gastrointestinal perforation represents a rare but potentially life-threatening complication. We report a case of fatal purulent peritonitis resulting from small bowel perforation caused by an impacted lower partial denture in a 60-year-old woman with significant neurological impairment residing in a nursing facility. The patient was admitted unconscious, and plain abdominal radiography reportedly revealed no significant abnormalities. Despite resuscitative efforts, she died shortly after hospital admission. Postmortem examination revealed diffuse purulent peritonitis and a 3-mm perforation of the terminal ileum within a dense inflammatory mass involving the ileocecal region. Marked adhesions were present in the lower abdominal cavity, and a lower partial denture with metallic clasps was found impacted at the perforation site. The surrounding mucosa showed ulcerations consistent with a subacute process. A large post-infarction cystic lesion of the cerebral hemisphere was also identified. Medical records indicated a previous cerebrovascular insult associated with hemiplegia and swallowing difficulties, which likely impaired communication and increased the risk of unnoticed foreign body ingestion. This case highlights the diagnostic limitations of plain radiography in foreign body ingestion, demonstrates how severe abdominal pathology may remain clinically unrecognized in neurologically impaired individuals, and emphasizes the crucial role of medicolegal autopsy in establishing the cause of death in unexpected hospital fatalities.