A Case of Accidental Esophageal Ingestion of a Deciduous Tooth Caused by Gastric Tube Insertion in a Patient with Trisomy 18

<p>Trisomy 18 is an autosomal abnormality syndrome and occurs in one in several thousand people. The life prognosis is extremely poor：the survival rate of 1 year or more is about 10％. We report a case of accidental ingestion of a deciduous tooth during gastric tube insertion in a child with trisomy 18 and its removal under fluoroscopy.</p><p>The patient was a girl aged 12 years and 2 months, diagnosed with trisomy 18 at birth, accompanied with esophageal atresia, ventricular septal defect, scoliosis, etc. She was medically dependent, with severe motor and intellectual disabilities, and nutritionally managed through a nasogastric tube. One day, there was a problem with the nasogastric tube. When it was reinserted, it was suspected that she had accidentally ingested a deciduous tooth-like foreign object. A detailed examination revealed a fresh wound in the gingiva corresponding to the upper right secondary deciduous molar, and a foreign body thought to be a fallen deciduous molar was lodged in the lower part of the esophagus. Initially, the patient was followed up for several days in the hope of spontaneous excretion, but no change in the position of the foreign body was observed. Thus, it was removed orally under fluoroscopy on the fourth day after accidental ingestion. The accidental ingestion of the deciduous tooth was thought to be caused partly by difficulty in inserting the nasogastric tube due to progressive deformation of the gastrointestinal tract due to scoliosis. After the operation, no serious complications occurred.</p><p>In patients who need daily medical care and are unable to express their symptoms themselves like this case, a more comprehensive oral management is needed considering the possibility that teeth may accidentally fall out for various reasons, or that a fallen tooth may go unnoticed.</p>