Prepared by Apurva B. Shah, MD, MPH, Senior Resident in Medicine; Arvind Suri, MD, Senior Resident in Medicine; and T. S. Dharmarajan, MD, FACP, AGSF, Chairman, Department of Internal Medicine, Our Lady of Mercy Medical Center, Bronx, NY

A 28-year-old man presented with abdominal pain, nausea, and a single episode of vomiting. Significant comorbities included depression and bipolar disorder. Physical examination was unimpressive except for multiple laparotomy scars. A plain radiograph of his abdomen showed a foreign body in the left upper quadrant, resembling a toothbrush (Figure). A careful retrospective history from the patient and family revealed that the patient had swallowed a toothbrush on a previous occasion. The patient underwent an uneventful laparotomy to have the toothbrush removed.

Points to remember: The plain abdominal radiograph is a widely available, safe, rapid, relatively inexpensive test that is underutilized in today?s high-tech world. In some cases of unexplained abdominal pain, this test can be diagnostic.

Diagnosis: Ingested toothbrush.

Figure—Radiographs of the abdomen showing a toothbrush.