Swallowing the bitter (metal) pill

Abstract

A 33-year-old female presented with a 1-day history of migratory right iliac fossae pain which initially began in the periumbilical region. This was associated with nausea, two non-bilious vomits and also a loss of appetite. She denied any urinary symptoms or vaginal discharge. She has no other medical or surgical issues. Examination of the patient showed her to be apyrexial with normal observations. She had some lower abdominal pain which was not too specific. Bloodwork showed a CRP of 165 mg/L with a WCC of 17.5 × 10 9 /L, neutrophil count of 15.1 × 10 9 /L. Beta HCG was negative.As part of her workup, she received a CT KUB which showed a dilated appendix with localized collection and also a metallic foreign body in the base of the appendix or in the caecum (Figs 1,2). We proceeded with diagnostic laparoscopy.She underwent a laparoscopic appendicectomy which showed free pus in the pelvis, right and left iliac fossae. An appendix in the pelvic position was seen to be inflammed and friable, as expected. The appendix was removed and it was bisected postoperatively by the operating surgeon. Surprisingly, we found the foreign body in the base of the appendix covered by faecal matter (Fig. 3) and seemingly causing a mass.The patient recovered well in the postoperative period and recounted a previously swallowed tongue piercing stud which she accidentally swallowed about 3 years ago. This correlated to the

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