Ingestion of nine metallic nails with corrosive: what happened next?

Abstract

A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.

Surgical Management of Massive Metal Bezoar

“…Children are more likely to ingest coins, toys, safety pins, or small batteries. However, adult patients usually present with meat and fish bones, toothpicks, denture parts, nails, pins, and screws as foreign bodies that have been accidentally ingested [ 5 ]. Intentional and repeated FB ingestion is encountered principally in adult patients with psychological disorders, intellectual disability, alcohol intoxication, prison inmates, and for drug smuggling [ 4 , 5 ].…”

“…Moreover, the esophagus is considered the most frequent obstruction site in the gastrointestinal tract due to either a physiological or pathological narrowing. Once the objects pass beyond the esophagus, the vast majority will probably exit the GI tract without complications [ 5 ]. Consequently, if no complications manifest, the clinical signs will be minimal or even absent [ 6 ].…”

“…Approaches to cases with FBs ingestion should be tailored according to the patient’s history and clinical examination. Furthermore, prompt management of certain cases should not be delayed for unnecessary investigations [ 5 , 8 ]. Biplane plain radiographs have been recommended as the initial modality for diagnosis, as they can not only identify most of FBs in the gastrointestinal tract but can also aid in detecting subsequent complications [ 7 ].…”

“…Multiple perspectives should be taken into account when managing FB ingestion patients, including patient’s age, clinical condition, FB features (length, size, number, type of material), anatomical site of ingested FB, and the expertise of the endoscopist. Although many foreign bodies ingested will pass spontaneously following conservative management, up to 20% of cases will require endoscopic retrieval, and rarely (1%) will require surgical intervention [ 5 ]. However, different groups from China, Korea, and Italy reported higher figures of FBs that had been removed endoscopically (80-90%), with other recent studies reporting the need for surgical intervention in up to 16% of cases [ 4 , 13 ].…”

“…Furthermore, it has been recommended that sharp objects like metallic nails should be removed even if the patient did not develop complications, since the morbidity and mortality are higher with these objects, particularly when it is associated with a large number of sharp objects as in the reported case [14]. Conversely, a wait-and-watch policy for a massive number of sharp FBs is an acceptable approach [5]. Hendry et al reported successful conservative treatment for a patient who had ingested 20 razor blades [15].…”