S2085 Narcosis by CO2: A Case of CO2 Cartridge Ingestion

Abstract

INTRODUCTION: Foreign body ingestion can impose serious clinical complications and needs prompt evaluations. We present a case of CO2 cartridge ingestion in a patient with psychiatric conditions. CASE DESCRIPTION/METHODS: A 30 year old male with history of schizophrenia and bipolar disorder presented with sore throat, chest pain, and homicidal ideation. His initial chest X-ray showed bilateral patchy airspace opacities concerning for pneumonitis. CT imaging was performed to better evaluate the infiltrates and incidentally revealed a large metallic canister shaped foreign body in the distal stomach. (Figure 1). Patient denied any ingestion but a confirmatory imaging was necessary to identify the foreign body. Abdominal x-ray confirmed a 9 × 2cm metallic canister without any evidence of obstruction (Figure 2). Given the size and location of the foreign body, an upper endoscopy was performed and identified a CO2 cartridge in the gastric body. The cartridge was successfully removed utilizing overtube and snare (Figure 3). The scope was then reinserted and confirmed no evidence of mucosal injury. Patient well tolerated the procedure and was discharged home following psychiatric clearance. DISCUSSION: Accidental foreign body ingestion commonly occurs in pediatric population, but in adults the incidents are often related to psychiatric disorders, intellectually impairment, substance intoxication, and patients seeking secondary gain. Studies have shown that the rate of endoscopic intervention and the need for surgical intervention are high (63–76% and 12–16% respectively) in the intentionally ingested incidents. The majority of foreign body ingestion pass without any intervention. However, due to risks of intestinal obstruction, hemorrhage, and perforation, the need for intervention is considered based on the content, size, shape, anatomic location, and time since ingestion of foreign body. The current guideline recommends an urgent endoscopy for objects >6cm in length at or above the proximal duodenum. Our patient, who had odynophagia but denied any ingestion, contained a 9 cm CO 2 cartridge in his stomach and required an urgent endoscopic retrieval. It is important for physicians to have a suspicion of foreign body ingestion in patients with gastrointestinal symptoms and long standing psychiatric history. In addition, long objects that are likely to cause an gastrointestinal obstruction require a prompt intervention.Figure 1.: Axial CT scan showing a metallic canister in stomach.Figure 2.: Abdominal X-ray showing a 9 × 2cm metallic canister in stomach.Figure 3.: A - CO2 Cartridge in gastric body. B - CO2 Cartridge retrieved with Overtube. C & D - CO2 Cartridge after retrieval.