Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Incidental, delayed diagnosis of gastric foreign body in a 15-year-old boy

Waleed A. Al-Busairi and Fawzi E. Ali
CMAJ June 10, 2003 168 (12) 1568-1569;
Waleed A. Al-Busairi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fawzi E. Ali
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Metrics
  • Responses
  • PDF
Loading

A 15-year-old boy with severe mental retardation was admitted to a long-term care institution. His parents mentioned their son's habit of putting nonedible items into his mouth but denied any episodes of his having ingested objects. A routine chest radiograph, ordered before admission to rule out tuberculosis, was read by a radiologist as being free of intrathoracic disease (Fig. 1).

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure 1. Photo: Images courtesy of Dr. Fawzi E. Ali

One year after being admitted to the institution, the boy temporarily became weak and unable to walk. Radiographs of the lumbar spine showed no spinal lesions, but a tube-like shadow under the left hemi-diaphragm was noted on an anteroposterior view (Fig. 2, arrows). This shadow was retrospectively appreciated on the earlier chest radiograph (Fig. 1, arrows). A plain abdominal radiograph revealed other gastrointestinal objects, including a bolt, a paper clip and several pins and screws (Fig. 3; arrows point to tube-like object detected on other radiographs). The boy was asymptomatic from a gastrointestinal perspective, and the smaller objects passed per rectum without incident over the next few weeks. The larger, tube-like object, later found to be a 16-cm long electrical cable with no wire inside, was retrieved from the stomach during an upper gastrointestinal endoscopy. The boy's esophagus, stomach and duodenal bulb appeared to be essentially unaffected by the cable. The institution's staff began to supervise the boy closely to prevent further ingestion of foreign bodies; follow-up radiographs revealed no further intra-abdominal foreign bodies.

Figure2
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure 3. Photo: Images courtesy of Dr. Fawzi E. Ali

Figure3
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure 2. Photo: Images courtesy of Dr. Fawzi E. Ali

Ingestion of foreign bodies is seen more frequently in children than in adults.1 Adults known to commonly ingest foreign bodies include prison inmates and people with mental illness.2 The prevalence of pica is 20% among mentally handicapped people, which puts this population at high risk for ingesting foreign bodies.3 Pica accounts for almost half of the laparotomies performed in mentally handicapped patients who present with an acute abdomen.4 The diagnosis and treatment of foreign body ingestion in mentally handicapped people can be difficult because of communication problems, altered pain sensation, and the physical disabilities and skeletal deformities associated with mental retardation.5

More than 80% of foreign bodies that reach the stomach will pass unimpeded through the gastrointestinal tract.6 However, those thicker than 2 cm and longer than 5 cm will tend to lodge in the stomach.7 Objects that lodge in the gastric lumen can remain there for long periods without adverse consequences.8 Complications of foreign body ingestion include obstruction (occurring particularly at the pyloric sphincter and ileocecal valve), perforation and hemorrhage. Perforation is more common in patients with previous abdominal surgery or intestinal disease.9 Watchful waiting is generally justified and may include administration of emetics, laxatives, or spasmolytics, depending on the type and site of object.1 However, early endoscopic or surgical removal of large foreign bodies from the stomach and of objects causing complications is recommended.2

People caring for mentally handicapped people should watch out for ingestion of foreign bodies, which may not result in symptoms initially. Routine abdominal radiographs may be indicated for people with pica. The whole radiograph, including areas not being specifically examined (e.g., extrathoracic tissues in a chest radiograph), should be checked carefully.

Waleed A. Al-Busairi Fawzi E. Ali Medical Rehabilitation Center UN Square Al-Sabah Health Zone Kuwait

References

  1. 1.↵
    Webb WA. Management of foreign bodies of the upper gastrointestinal tract. Gastroenterology 1988;94:204-16.
    OpenUrlPubMed
  2. 2.↵
    Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 1996;20:1001-5.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Danford DE, Huber AM. Pica among mentally retarded adults. Am J Ment Defic 1982;87:141-6.
    OpenUrlPubMed
  4. 4.↵
    Voitk AJ. Acute abdomen in severely mentally retarded patients. Can J Surg 1987;30:195-6.
    OpenUrlPubMed
  5. 5.↵
    Decker CJ. Pica in the mentally handicapped: a 15-year surgical perspective. Can J Surg 1993;36:551-4.
    OpenUrlPubMed
  6. 6.↵
    Selivanov V, Sheldon GF, Cello JP, Crass RA. Management of foreign body ingestion. Ann Surg 1984;199:187-91.
    OpenUrlPubMed
  7. 7.↵
    Koch H. Operative endoscopy. Gastrointest Endosc 1977;24:65-8.
    OpenUrlPubMed
  8. 8.↵
    Roark GD, Subramanyam K, Patterson M. Ingested foreign material in mentally disturbed patients. South Med J 1983;76:1125-7.
    OpenUrlPubMed
  9. 9.↵
    Henderson CT, Engel J, Schlesinger P. Foreign body ingestion: review and suggested guidelines for management. Endoscopy 1987;19:68-71.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

CMAJ
Vol. 168, Issue 12
10 Jun 2003
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Incidental, delayed diagnosis of gastric foreign body in a 15-year-old boy
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Incidental, delayed diagnosis of gastric foreign body in a 15-year-old boy
Waleed A. Al-Busairi, Fawzi E. Ali
CMAJ Jun 2003, 168 (12) 1568-1569;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Incidental, delayed diagnosis of gastric foreign body in a 15-year-old boy
Waleed A. Al-Busairi, Fawzi E. Ali
CMAJ Jun 2003, 168 (12) 1568-1569;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Smith-Magenis syndrome
  • Smith-Magenis syndrome
  • Google Scholar

More in this TOC Section

Practice

  • Painful periods in adolescents
  • Hairy tongue
  • Tocilizumab for hospitalized patients with COVID-19
Show more Practice

Clinical Vistas

  • The mystery of the broken bones
  • Elderly woman with rapidly growing, ulcerated pigmented lesion
  • Cat naps: an elderly woman with recurrent syncope
Show more Clinical Vistas

Similar Articles

Collections

  • Topics
    • Imaging
    • Gastroenterology
    • Eating disorders

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, CMA Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire