An unusual long foreign body impacted in D1–D2 with impending perforation managed laparoscopically: A case report

Accidental ingestion of long foreign bodies is uncommon in adults, and objects such as toothbrush handles rarely pass spontaneously. We report a 32-year-old man who presented days after ingesting the handle of a toothbrush with a 3-day history of generalized, colic abdominal pain aggravated by oral intake and associated vomiting. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a long tubular/linear foreign body (approximately 14 cm) extending from the duodenal bulb across the second part of the duodenum up to the junction of the second and third parts, with surrounding inflammatory changes and minimal fluid but without free intraperitoneal air or localized collection. Upper gastrointestinal endoscopy confirmed an impacted plastic foreign body; gentle manipulation demonstrated embedding with threatened perforation, and endoscopic retrieval was deferred. The patient underwent laparoscopic foreign body removal. Intraoperatively, the toothbrush handle was seen perforating the anterior wall of the first part of the duodenum and abutting the gallbladder. After extraction, the duodenal defect (approximately 1.5 x 1.5 cm) was closed and reinforced with an omental patch, and a laparoscopic Witzel feeding jejunostomy was created. Recovery was uncomplicated, enteral feeds were established, and the patient was discharged on postoperative day 5 with planned outpatient follow-up and psychiatric review.