Foreign body ingestion: "I swallowed a pen"
22 year old female presents to the ER with a complaint of swallowing a pen two days ago. She has had vomiting and epigastric pain since then. The patient has a long history of similar behavior in the past. During the last admission one month ago, she had an EGD with a pen removal followed by a spoon ingestion on the ward, requiring a second endoscopy. She also reports eating "a call button" at another facility recently, "they said it was in my colon." She denies being suicidal.
PTSD, depression, intentional FB ingestions, heroin abuse
Open foreign body (FB) removal 4 times in the past
Smoking, heroin IV abuse
What would you do?
Excessive stool is present in the colon. There is a right-sided groin catheter. Overlying the stomach or perhaps within the stomach is a linear lucency measuring approximately 12.5 cm. It has a metal tip.
Previous KUB from one month ago:
The call button is located in the right upper quadrant, ejecting over both the duodenum and colon. There is no free air. The bowel gas pattern is nonobstructive. There is a right-sided groin catheter.
Plain X-ray films were reviewed with radiology: there was a metallic FB in the stomach that looked like a pen tip, there was also a metallic FB in transverse colon, no evidence of perforation or obstruction.
The patient was admitted to a general medicine floor with a sitter. Psychiatry and GI consults were called.
If you were called, which way you prefer to remove the object?
Click Here to know how it was removed:
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