836 AJR:198, April 2012

or abdominal pain after ingestion of grilled meat. Careful history revealed that in all cas-es the patients had eaten meat cooked on a grill that was cleaned with a wire brush im-mediately before cooking. Patients included five female and one male subject ranging in age from 11 to 75 years. All patients present-ed to the emergency department within 24 hours of ingestion (range, 2–24 hours).

Three patients presented with acute ody-nophagia as a primary symptom. Two un-derwent radiography of the neck only, which revealed a metallic foreign body, and one pa-tient proceeded directly to CT, which iden-tified and localized the foreign body within the neck (Fig. 1).

Both patients with radiographic evidence of foreign body within the neck underwent immediate laryngoscopy. In the first patient, the wire was easily visualized and removed. In the second patient, the wire was not im-mediately visualized because of extensive surrounding soft-tissue edema, and the pro-cedure was abandoned. Laryngoscopy was repeated 6 days later, and the wire was iden-tified and removed. In the patient who un-derwent neck CT, the wire was suspected to have perforated into the tonsils, and tonsil-lectomy was performed. Pathologic analysis did not reveal a foreign body, and the patient remained symptomatic. The wire was then identified under direct visualization 2 weeks later and was removed without complication.

Three patients presented with abdominal pain as their dominant symptom and underwent CT of the abdomen and pelvis in the emergen-cy department. In two patients, the foreign body

Inadvertent Ingestion of Wire Bristles From a Grill Cleaning Brush: Radiologic Detection of Unsuspected Foreign Bodies

David J. Grand1

David R. CloutierMichael D. BelandWilliam W. Mayo-Smith

Grand DJ, Cloutier DR, Beland MD, Mayo-Smith WW

1All authors: Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, 593 Eddy St, Providence, RI 02903. Address correspondence to D. J. Grand (dgrand@lifespan.org).

Gastrointest ina l Imaging • Cl in ica l Perspect ive

AJR 2012; 198:836–839

0361–803X/12/1984–836

© American Roentgen Ray Society

Foreign body ingestion is a com-mon cause for emergency depart-ment visits, usually in the pediatric population. In 1999, the American

Association of Poison Control documented 182,105 incidents of foreign body ingestion by patients younger than 20 years [1]. Seri-ous morbidity occurs in less than 1% of all cases [2]. Up to 90% of foreign bodies that have traveled beyond the esophagus will pass spontaneously; however, endoscopic remov-al is recommended for sharp or large objects that are within reach of the endoscope [3]. Sharp foreign bodies within the esophagus are endoscopically removed, whereas blunt objects may be advanced into the stomach.

The literature on foreign body ingestion in adults is scant, consisting mainly of case re-ports. Objects described include a comb [4], a table knife [5], and a toothpick [6], with re-ported complications including obstruction, perforation, and gastrointestinal bleeding.

To our knowledge, there are two case re-ports in the literature describing upper gas-trointestinal tract injury secondary to inges-tion of a wire bristle from a grill cleaning brush. In each case, the patients reported sud-den onset of pain after eating meat cooked on a recently cleaned grill. Ingestion led to per-foration and abscess formation in both cas-es, one of which was sublingual and the other was paraesophageal in location [7, 8].

Clinical History and PresentationOver the course of 18 months, six patients

presented to our emergency department com-plaining of acute onset of either odynophagia

Keywords: CT, foreign body, odynophagia

DOI:10.2214/AJR.11.6991

Received March 31, 2011; accepted after revision August 4, 2011.

OBJECTIVE. We report acute onset of either odynophagia or abdominal pain immediately after ingestion of grilled meat in six patients presenting between May 1, 2009, and November 18, 2010. In all six patients, radiologic studies revealed a linear metallic foreign body. Careful history revealed cleaning of the grill with a metallic brush immediately before cooking in all six cases.

CONCLUSION. Physicians should be aware of this potential hazard to facilitate accu-rate and timely diagnosis.

Grand et al.Accidental Ingestion of Wire Brush Bristle

Gastrointestinal ImagingClinical Perspective

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Accidental Ingestion of Wire Brush Bristle

F O R Y O U R I N F O R M A T I O N

This article is available for CME credit. See www.arrs.org for more information.

was visualized perforating the wall of the jeju-num (Fig. 2). In the third patient, the wire perfo-rated through the stomach into the liver and was surrounded by a large hepatic abscess (Fig. 3).

Laparoscopy was immediately performed on the basis of CT and clinical findings in the two patients with proximal small-bowel per-foration, and the foreign body was easily iden-tified and removed. Length of stay for these

patients ranged from 1 to 4 days. The patient in whom the wire was identified within the liv-er on CT underwent laparotomy and anatomic partial hepatectomy to remove the hepatic ab-scess. The wire was not identified at patholog-ic analysis, but we suspect this was because of a sampling error in pathologic analysis (i.e., a specimen radiograph was not obtained). The patient was discharged after 6 days.

DiscussionAlthough foreign body ingestion is not a

rare complaint in the emergency department, it is striking that in only 18 months we iden-tified six separate episodes of wire bristle in-gestion after eating grilled meat. All patients presented within 24 hours of ingestion. The severity of the ingestion ranged from odyno-phagia, with subsequent endoscopic removal,

D

A

Fig. 1—67-year-old woman with acute onset of odynophagia after eating grilled hamburger. A, Lateral radiograph shows linear radiodense foreign body (arrow) within soft tissues of neck. B and C, Axial (B) and coronal (C) CT images show foreign body (arrows) perforating through wall of esophagus with extensive surrounding soft tissue air. D–F, Volume-rendered images from same CT scan aid precise localization of foreign body (arrows).

F

C

E

B

838 AJR:198, April 2012

Grand et al.

to gastrointestinal perforation and hepatic ab-scess formation. In patients presenting with odynophagia, radiography of the neck may successfully identify the wire bristle, which will be significantly denser than the more commonly encountered fish bone. When a foreign body is identified within the neck, CT may be helpful for anatomic localization and procedural planning.

CT scan without oral contrast agent is rec-ommended for patients presenting predomi-nantly with abdominal pain. We do not rou-tinely administer oral contrast agent in the emergency department; however, it should specifically be avoided when there is sus-picion of foreign body, because hyperat-tenuating oral contrast agent can potential-ly obscure a radiopaque foreign body. This clinical scenario needs to be considered by physicians whenever patients present with acute pain after ingestion of grilled food.

A

A

C

C

B

B

Fig. 2—45-year-old woman with acute onset of abdominal pain after eating grilled chicken. A, Axial contiguous CT images show linear foreign body (arrows) perforating wall of proximal small intestine. B, Coronal reformatted image nicely localizes foreign body (arrow). C, Wire bristle was retrieved at laparoscopy.

Fig. 3—75-year-old woman with acute onset of abdominal pain after eating grilled steak. A and B, Coronal reformatted images show metallic foreign body (arrows) perforating into liver with surrounding hepatic abscess. C, Axial CT image shows tip of foreign body (arrow) within hepatic abscess.

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