title: The case of the forgotten toothbrush.
abstract: BACKGROUND
  Although foreign body ingestion is relatively common, toothbrush swallowing is rare. A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis.
  
  
  METHODS
  We report a case of a swallowed toothbrush which passed past the pylorus and perforated the terminal ileum. The patient however presented with a fluctuant mass in the left iliac fossa, pyrexia and generalised tenderness mimicking a diverticular abscess.
  
  
  CONCLUSIONS
  Ingestion of a foreign body is commonly encountered in the clinic among children, adults with intellectual impairment, psychiatric illness or alcoholism, and dental prosthetic-wearing elderly subjects. However, toothbrush swallowing is rare, with only approximately 40 reported cases.
  
  
  CONCLUSIONS
  Bowel perforation by foreign bodies can mimic acute appendicitis and should be considered in differential diagnoses. Clinically, patients often do not recall ingesting the foreign body, which makes the clinical diagnosis more challenging, and a correct diagnosis is frequently delayed. Several radiological investigations, such as small-bowel series, ultrasonography, and computed tomography scans, may lead to the correct diagnosis, but in most patients, the diagnosis is not confirmed until the surgical intervention has been performed.
authors.affiliation: Department of General Surgery, North Tyneside General Hospital, Rake Lane North Shields NE29 8NH, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Sewpaul
authors.forename: F
authors.initials: F
authors.lastname: Shaban
authors.forename: A K
authors.initials: AK
authors.lastname: Venkatasubramaniam
authors.forename: D
authors.initials: D
authors.lastname: Tennant
authors.forename: S B
authors.initials: SB
authors.lastname: Kelly