title: A Case of Mysterious Impacted Duodenal Foreign Body Presenting with Halitosis.
abstract: The majority of gastrointestinal (GI) foreign bodies (FBs) discovered in adults are the result of intentional ingestion, most of which are found in patients with a preexisting psychiatric illness, with substance abuse disorders, or in people seeking secondary gain. No similar case of internal injuries following unintentional ingestion of a barbecue grill cleaning brush bristle has been reported. A 58-year-old Caucasian male with no significant history presented with complaint of halitosis, not improving after oral care and dental hygiene measures. He denied any other symptoms. After ruling out oral causes of halitosis, an esophagogastroduodenoscopy was performed, which revealed a black wire-shaped metallic FB embedded in the duodenum. The FB was identified as a silver metallic flexible wire resembling the bristle of a barbecue grill cleaning brush. The halitosis resolved completely within 3 weeks of the removal of the FB. To the best of our knowledge, this is the first case of duodenal impaction of a barbecue grill cleaning brush bristle atypically presenting with halitosis. Physicians' awareness of this potential injury from grill cleaning brush bristles would lead to a quick diagnosis after a focused history. Also avid grillers must be made aware of this potential hazard and should be encouraged to carefully examine the barbecue grill surface for any remnant bristle of the grill cleaning brush. Appropriate history taking, considering GI causes as potentially inducing halitosis, and an awareness of this entity among providers are important to facilitate prompt diagnoses and prevent major adverse outcomes.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center, Houston, TX, USA; Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Bhavtosh
authors.initials: B
authors.lastname: Dedania
authors.affiliation: Department of Medicine, Montefiore Medical Center - North Division, Bronx, NY, USA.
authors.forename: Dipen
authors.initials: D
authors.lastname: Khanapara
authors.affiliation: Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Amruta
authors.initials: A
authors.lastname: Panwala
authors.affiliation: Department of Gastroenterology, Saint Francis Hospital, Hartford, CT, USA.
authors.forename: Murali
authors.initials: M
authors.lastname: Dharan
keywords: Barbecue brush bristles; Duodenal foreign body; Food grille; Gastrointestinal foreign body; Halitosis