Foreign Body Ingestion: "I Swallowed a Pen"

Author: V. Dimov, M.D., University of Chicago
Reviewer: A. Kumar, M.D., Cleveland Clinic

A 24-year-old female presented to the emergency room (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 esophagogastroduodenoscopy (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.

Past medical history (PMH)

Post-traumatic stress disorder (PTSD), depression, intentional foreign body (FB) ingestions, heroin abuse.

Past surgical history (PSH)

Open foreign body (FB) removal 4 times in the past.

Medications

None.

Social history (SH)

Smoking, heroin IV abuse.

Physical examination

Vital signs - stable (VSS).
Normal examination.

What would you do?

Complete blood count (CBC), basic metabolic panel (BMP).
X-ray of kidneys, ureters, and bladder (KUB).


Current KUB: 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 (click to enlarge the images).


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 (click to enlarge the images).

What happened?

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. The pen was removed through an EGD.

Final diagnosis

Foreign body ingestion.

Related reading


Gastric foreign body (toothbrush) seen on endoscopy. Image source: Wikipedia, public domain.
Bladder Foreign Body. NEJM, 06/2008.
There Was a Young Man Who Swallowed a Nail...Perhaps He'll Die. Medscape, 12/2008.
Swallowed Objects That Went Straight Into History - NYTimes, 2011.

Published: 03/12/2006
Updated: 01/15/2011

1 comment:

  1. Alexandre Benedito Neves Rodrigues5/02/2011 8:08 PM

    Several studies have demonstrated efficacy for pharmacological interventions. Naltrexone and clonidine have led to decreases in both the impulsive drive to self-harm as well as the frequency of self-injury.What is your experience ????
    Thanks,
    Alexandre Benedito Neves Rodrigues, Sao Paulo-Brazil.

    ReplyDelete