It’s kind of a tradition, on Independence Day, for health journalists to relay warnings from public-health authorities. Wear sunscreen, watch the alcohol, don’t leave kids alone in pools, don’t stick sparklers in your eye — that kind of thing. They are important to say, because they might actually prevent someone getting injured, but they are dully familiar, because we’ve heard them all before.
Here’s one I suspect no one has heard before: Don’t swallow your grill brush, it will puncture your intestine.
The warning comes — with pictures! — from the Centers for Disease Control and Prevention, via its weekly disease-and-death bulletin, the Morbidity and Mortality Weekly Report. Since 2009, radiologists at the Warren Alpert School of Medicine at Brown University in Rhode Island have seen 12 people — men, women and kids — who came into the emergency department reporting pain on swallowing or somewhere in the neck, or severe pain in the abdomen. On analysis, the diagnosis was always the same. A wire bristle that had snapped off a grill-cleaning brush had gotten into their food and then pierced whatever tissues it happened to snag on the way down: tongue, throat, or somewhere in the abdomen.
The report published last night, written by the radiologists, describes their most recent cases: five men (31, 35, 50, 50, and 64) and one woman (46), who came to their hospital between March 2011 and last month. Aside from living nearby, they had only one notable thing in common. As the authors describe it: “Patient interviews revealed a common history of recent ingestion of grilled meat.”
The woman and two of the men reported severe pain on swallowing. The radiologists — suspecting from their earlier cases what they ought to be looking for — sent them through X-rays and CT scans and identified short pieces of wire. In two cases, the wire was lodged into the tissues of the throat; in one man’s case it speared the base of his tongue.
Those three got off lightly compared to the others. The youngest man had a piece of wire still inside his intestine, but poking at the wall hard enough to dent his bladder; he got a colonoscopy. In the two remaining cases, the wire worked its way through the intestinal wall and into the abdominal cavity, and required emergency surgery to extract the wire and sew up the perforated intestine before infection set in.
So where did these wires come from? Given the patients’ descriptions of what they had been doing (and eating) and inspection of the wires after they were retrieved, the physicians assert the culprits were stray bristles from the brushes that almost anyone who grills uses to scrub grates clean. They assume the pressure of scrubbing torqued some individual wires and snapped them, leaving the wires on the grates, where they stuck to food that was laid on top of them when grilling started again.
(Which, based on my n of 1, seems a reasonable assumption. That image at the top is my grill brush, which I’ve used maybe six times since buying it last month. When I read this paper, I went out to look, and, yup: bent bristles in the corner cluster. Oops.)
So: This sounds like a tongue-in-cheek disease-detection story: bizarre event, nobody died; another beer? But if you think about it, as the Rhode Island authors clearly have, this could be serious. The lengths of wire — about 1/2-inch on my brush — are short enough for an adult to swallow without noticing, but they could potentially choke a child. Even in adults, they’ve had serious effects: Among the earlier cases seen at Warren Alpert were two where the wires were not found right away (because at the time no one knew to look for them) and the patients developed tongue and throat abscesses. In an earlier case in Philadelphia — yes, it turns out there’s a literature on this — a tongue abscess from an embedded wire was so severe the patient couldn’t breathe properly and developed “altered mental status.”
Part of the point of publishing this paper is to alert physicians and other health professionals to a possible diagnosis, in case they see any weird mouth- or stomach-pain cases over the coming days: the faster a patient with one of these embedded wires gets to radiology, the better their outcome is likely to be.
But part of the point is also to alert people living their everyday lives. So when you fire up the grill this afternoon, go ahead and scrub off the yucky bits. But take a hard look at the grates afterward for anything spiky or shiny. Holidays in the ER are no fun.
Cite: Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012. MMWR. July 3, 2012 / 61(Early Release);1-3.
Top image, Maryn McKenna; Second image, CDC/Warren Alpert School of Medicine.