Fishing in the Colon

Abstract

In many cases of ingested foreign bodies patients present with dysphagia, neck tenderness, and abdominal pain and distention. We present an interesting case of a patient who ingested a sharp object that traveled through the GI tract and lodged into his left colon. A 57 year old male with a past medical history significant for gastroesophageal reflux disease presents for a sharp left upper quadrant pain over the past three days. He reported a normal bowel movement the day prior to presentation. Abdominal exam was consistent with tenderness to palpation in the left upper quadrant (LUQ). Labs on admission were significant for a white blood cell count of 17,000, total bilirubin of 0.7, alkaline phosphatase of 58, ALT of 51, and AST of 25. CT abdomen/pelvis done on admission showed a linear hyperdense structure, likely a fissural bone, protruding through the wall of the left colon and diverticula that are scattered throughout the colon and worst in the sigmoid colon. Colonoscopy the following day showed a 3.4 cm long fishbone protruding through the colonic wall and this was removed using a snare and a foreign body hood protector. Common sites of foreign body impaction include the upper esophageal sphincter, level of aortic arch, diaphragmatic hiatus, pylorus, and ileocecal valve. This case was unusual since the bone passed these locations before becoming lodged in the left colon. Complications of foreign body ingestion include ulcer formation, laceration, perforation, intestinal obstruction, aortoesophageal fistula formation, and tracheoesophageal fistula formation. Early endoscopy for removal is recommended for esophageal objects, sharp-pointed objects, and objects more than 6 cm. Surgery may be required if endoscopic intervention fails. Thus, it is important for gastroenterologists and internists to be aware that ingested foreign bodies should undergo early and prompt intervention.1568_A Figure 1. CT scan of Foreign Body1568_B Figure 2. Foreign Body on Colonoscopy1568_C Figure 3. Foreign Body on Colonoscopy