Every Cent Counts: A Case of Foreign Body Ingestion

Abstract

Foreign body ingestion represents a relatively common reason for gastroenterologist consultation. While over 80% of swallowed foreign bodies will ultimately pass uneventfully through the gastrointestinal tract, 10-20% of cases will require endoscopic retrieval. We present an unusual case of foreign body ingestion involving a patient presenting with abdominal pain and melena. A 68 year-old man with a history of coronary artery disease presented to the hospital with a 3 day history of unremitting, burning epigastric pain associated with 1 episode of melenic stool. He denied hematochezia and weakness but did endorse a history of non-steroidal anti-inflammatory use. Upon admission he was found to be hemodynamically stable. Laboratory values including complete blood count, basic metabolic panel, and protime were unremarkable. Plain abdominal film on admission revealed an elongated radiopaque object concerning for foreign body in the antrum. The patient denied ingestion of any known non-food items. Upper endoscopy was performed. An elongated Forrest 2c 7mm x 2cm pyloric ulcer was discovered (figure 1). On retroflexion in the stomach, a quarter was visible in the greater curvature (figure 2). Closer inspection revealed a dime underneath the first coin (figure 3). Both coins were successfully retrieved with the Roth retrieval net. Biopsies for Helicobacter Pylori were negative. The patient was started on 40mg esomeprazole daily and was soon discharged with a plan for repeat upper endoscopy in 3 months. While the majority of ingestions can be managed with conservative measures, cases with airway compromise or peritoneal signs often call for urgent endoscopic or surgical evaluation. Concerning ingestions include sharp objects, disk batteries, magnets, or items with diameter greater than 25mm as they are less likely to pass through the pylorus. Ingestion of foreign non-food objects is more commonly encountered in the pediatric population with coins representing the majority of cases. When seen in adults, there is usually concomitant alcoholism or cognitive and psychiatric disorders. In our patient's case, there was a history of excessive alcohol abuse. It is likely that the coins were ingested while intoxicated. The patient's use of non-steroidal anti-inflammatory drugs likely lead to ulcer development; however, it is possible that the coins may also have contributed as ulcers have been reported with similar blunt objects.Figure 1Figure 2Figure 3