A CASE REPORT Ingestion of Nineteen Nails and Successful ... · 60 PRACTICAL GASTROENTEROLOGY •...
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60 PRACTICAL GASTROENTEROLOGY • MARCH 2012 A CASE REPORT Khurram Abbass MD 1,2 Sanjay Sandhir MD 2 , Ronald Markert PhD 2 , Nasir A Khan MD 3 , Waheed Gul MD 2 Dayton Veterans Affairs Medical Center, Dayton, OH 1 Dayton Veterans Affairs Medical Center, Dayton, OH, 2 Wright State University, Boonshoft School of Medicine, Dayton, OH 3 Grand Rapids Medical Education Partners and Michigan State University, College of Human Medicine, Grand Rapids, MI A 49-year-old Caucasian male presented to the emergency room with the chief complaint of depression. He also reported swallowing numerous finishing nails. He had a significant psychiatric history with ingestion of foreign bodies before, including blade pieces, combs and plastic objects. On presentation, he reported epigastric pain but denied hematemesis or rectal bleeding. In the emergency room, chest and abdominal x-rays confirmed the presence of ingested nails in the abdomen without pneumoperitonium (Figure 1). His abdominal examination was negative for guarding or rebound tenderness although he had subjective tenderness in the epigastric area. Endoscopic removal was attempted under general anesthesia and orotracheal intubation. The esophagogastroduodenoscope and overtube were passed into the stomach. The nails were located in the jejunum Ingestion of Nineteen Nails and Successful Removal by Khurram Abbass, Sanjay Sandhir, Ronald Markert, Nasir A Khan, Waheed Gul Figure 1. Plain abdominal radiograph showing foreign bodies. Figure 2.Endoscopy of the upper gastrointestinal system showing multiple finishing nails in the jejunum. (Figure 2). With a snare, some nails were moved into the stomach and removed through the overtube. Since an adult gastroscope could not be advanced satisfactorily into the jejunum, a pediatric colonoscope was used. This method facilitated removal of the remaining nails (for a total of 19). The patient tolerated the procedure well and post-procedure radiographs of the chest and abdomen showed no remaining nails and ruled out perforation. Intentional swallowing of foreign objects is not common but is a notable phenomenon in patients with underlying psychiatric disorders. Most ingested foreign bodies pass through the gastrointestinal tract uneventfully. Complications have been reported in up to 35% of patients who ingest sharp or pointed objects. 1 The patient above was fortunate in that the nails that he intentionally ingested did not cause perforation and were removed without incident. Surgical intervention may be necessary if perforation occurs. ■ Reference 1. Kılcıler G, Kantarcioğlu M, Turan İ, Uygun A, Bai S. Stomach full of ingested foreign bodies: more than a “metallic taste”. Turk J Gastroenterol. 2010 Sep;21(3):322-3. Case Report2_March_12.indd 60 3/13/12 11:20 AM
Transcript of A CASE REPORT Ingestion of Nineteen Nails and Successful ... · 60 PRACTICAL GASTROENTEROLOGY •...
60 PRACTICAL GASTROENTEROLOGY • MARCH 2012
A CASE REPORT
Khurram Abbass MD1,2 Sanjay Sandhir MD2, Ronald Markert PhD2, Nasir A Khan MD3, Waheed Gul MD2
Dayton Veterans Affairs Medical Center, Dayton, OH 1Dayton Veterans Affairs Medical Center, Dayton, OH, 2Wright State University, Boonshoft School of Medicine, Dayton, OH 3Grand Rapids Medical Education Partners and Michigan State University, College of Human Medicine, Grand Rapids, MI
A49-year-old Caucasian male presented to the emergency room with the chief complaint of depression. He also reported swallowing numerous
finishing nails. He had a significant psychiatric history with ingestion of foreign bodies before, including blade pieces, combs and plastic objects.
On presentation, he reported epigastric pain but denied hematemesis or rectal bleeding. In the emergency room, chest and abdominal x-rays confirmed the presence of ingested nails in the abdomen without pneumoperitonium (Figure 1). His abdominal examination was negative for guarding or rebound tenderness although he had subjective tenderness in the epigastric area.
Endoscopic removal was attempted under general anesthesia and orotracheal intubation. The esophagogastroduodenoscope and overtube were passed into the stomach. The nails were located in the jejunum
Ingestion of Nineteen Nails and Successful Removalby Khurram Abbass, Sanjay Sandhir, Ronald Markert, Nasir A Khan, Waheed Gul
Figure 1. Plain abdominal radiograph showing foreign bodies.
Figure 2.Endoscopy of the upper gastrointestinal system showing multiple finishing nails in the jejunum.
(Figure 2). With a snare, some nails were moved into the stomach and removed through the overtube. Since an adult gastroscope could not be advanced satisfactorily into the jejunum, a pediatric colonoscope was used. This method facilitated removal of the remaining nails (for a total of 19). The patient tolerated the procedure well and post-procedure radiographs of the chest and abdomen showed no remaining nails and ruled out perforation.
Intentional swallowing of foreign objects is not common but is a notable phenomenon in patients with underlying psychiatric disorders. Most ingested foreign bodies pass through the gastrointestinal tract uneventfully. Complications have been reported in up to 35% of patients who ingest sharp or pointed objects.1
The patient above was fortunate in that the nails that he intentionally ingested did not cause perforation and were removed without incident. Surgical intervention may be necessary if perforation occurs. ■
Reference
1. Kılcıler G, Kantarcioğlu M, Turan İ, Uygun A, Bai S. Stomach full of ingested foreign bodies: more than a “metallic taste”. Turk J Gastroenterol. 2010 Sep;21(3):322-3.
Case Report2_March_12.indd 60 3/13/12 11:20 AM
