Surgeon Has Yet to Get Bellyful of His Research Into Swallowing

A doctor who has studied why people swallow foreign objects and who has also plucked a few toothbrushes from aching stomachs says sometimes life is stranger than fiction.

Writing in the Archives of Surgery, Dr. Allan D. Kirk said an outbreak of toothbrush swallowings by his patients recently has convinced him that toothpaste and alcohol don’t mix.

Or for that matter, neither do toothpaste and clumsiness or being in the midst of a violent coughing spell with a toothbrush in your mouth.

Two of Kirk’s patients were intoxicated when they inadvertently gobbled down their toothbrushes; one was having a coughing fit and the other apparently just wasn’t paying enough attention to the job at hand.

Used Endoscope

These instances of swallowed toothbrushes all occurred within a short time of each other and all were treated by surgeon Kirk, who says the problem wasn’t how the toothbrushes wound up in the victims’ stomachs but how to get them out.

With the aid of an endoscope, a telescope-like instrument that permits a view of the body’s dark cavities, and grabbing the toothbrush with a surgical wire, or forceps, Kirk and his team got them out.

“We saw these four people almost one right after the other with toothbrushes in their GI (gastrointestinal) tracts. So we decided to look up how many times this has happened,” said Kirk in a telephone interview from the Duke University Medical Center in Durham, N.C.

He says there have been only 31 recorded cases of swallowed toothbrushes worldwide since the 19th Century, about half of that number involving a single psychiatric patient in the Soviet Union four years ago.

But Kirk’s curiosity got the better of him and led to an investigation of all sorts of swallowed objects, from silverware to nails.

“Knives were the only reported gastric foreign bodies requiring removal (by surgery) for 207 years, until other silverware such as spoons and forks made their way into the gastrointestinal tract,” he said.

Eventually, a piece of earthenware was recorded in the medical literature, he noted, to complete a place setting.

30 Frogs Swallowed

“In one case in France, a guy swallowed 30 frogs--that’s right, frogs as in ‘ribbit’--and they almost made it all the way through, if you know what I mean,” the surgeon said.

But Kirk’s investigations also revealed that, once inside, toothbrushes will stay there unless they are surgically removed.

“No one knows why toothbrushes won’t go all the way through because other things have passed, like 14-inch nails,” he remarked.

“I know that some of this sounds stranger than fiction,” Kirk said.

Accidents account for many of the cases, especially instances in children who ingest coins and small toys, he said.

The first reported removal of a toothbrush was performed in 1882 by a surgeon, Dean Beattie, who was practicing in Hong Kong, Kirk said. The object was removed by gastrotomy--a surgical incision into the stomach--after the object remained in the victim’s stomach for five days.