University of Miami, Jackson Memorial Hospital Miami, FL
Smriti Kumar, MD, EdM1, Sanjay Jain, MD2; 1University of Miami, Jackson Memorial Hospital, Miami, FL; 2Southend Gastroenterology Associates, Louisville, KY
Introduction: Psychiatric patients have a higher risk of foreign body ingestions and usually are privy to recurrent episodes. They also often present with multiple foreign bodies at a time. We describe an unusual case, where multiple sharp pencils were ingested in a suicide attempt by an adult patient with history of alcoholism and depression.
Methods: A 44-year-old Caucasian female was admitted to a psychiatric hospital with depression and alcohol abuse. She complained of epigastric pain. Further questioning revealed that she had ingested 7 small lead pencils in an apparent suicide attempt.KUB at the facility showed multiple foreign linear bodies in the left upper quadrant consistent with the patient’s history of pencil ingestion. She was transferred to the local main hospital and admitted to the inpatient service. Her physical exam was remarkable for mild left upper quadrant tenderness. Her complete blood count was unremarkable. Serum chemistries show elevated transaminases consistent with alcoholic hepatitis. Alcohol level was less than 5. A CT scan was performed which showed hepatic steatosis and multiple foreign bodies in the stomach. No signs of bowel perforation or obstruction were noted. The patient was intubated and underwent endoscopy under general anesthesia for airway protection. Seven pencils about 7-8 cm each in length were seen lying in the gastric body. An attempt was made to use a tripod, which was unsuccessful. Subsequently, the pencils were carefully grasped with a polypectomy snare very close to the blunt end while the sharp end trailed downward to reduce chances of injury as it was pulled out along with the scope. Multiple passes were made removing each pencil individually. Pencils were counted. No injuries were noted and patient tolerated the procedure well. A follow-up KUB was ordered to ensure no pencils had traveled further into the duodenum.
Discussion: Urgent endoscopic removal was indicated due to the sharp pointed pencil tips which could lead to possible complications including perforation, peritonitis, abscess formation, sepsis and hematoma formation. In this case, a polypectomy snare was utilized to successfully remove multiple sharp pencils from the stomach. Retrieval baskets, transparent caps, and latex rubber hoods can also be used to remove such sharp objects endoscopically.
KUB showing multiple foreign linear bodies in the left upper quadrant.
Endoscopic view of the seven pencils about 7-8 cm each in length in the gastric body.
Successful removal of all seven pencils.
Disclosures: Smriti Kumar indicated no relevant financial relationships. Sanjay Jain indicated no relevant financial relationships.