A 42-year-old man was brought to the emergency department (ED) for abdominal discomfort. EMS reported a history of syncope and pica. The patient stated that his stomach “hurt” after swallowing several items over the last two days.
Physical examination revealed normal vital signs: alert and oriented, speaking comfortably, in no acute distress. Lungs were clear, heart rate and rhythm were normal, and his abdomen was moderately tender in the epigastric region without peritoneal signs or rebound, normal bowel sounds, and no surgical scars. The neurological examination was normal. Labs, chest X-ray (CXR), and abdominal kidney, ureter, and bladder (KUB) radiographs were ordered.
Image 2. (Click to enlarge.)
CXR AP (see Image 1) and Lateral (see Image 2) and KUB (see Image 3) revealed multiple round and other shaped radiopaque foreign bodies (FBs) in the gastrointestinal (GI) tract.
The X-rays revealed round FBs of one density consistent with a coin in the distal esophagus and two stacked in the stomach (discussed in my last column; see yellow arrows).1 It also revealed rough-ended cylindrical FBs in the stomach (see blue arrows). Imaging additionally revealed round and flat FBs of varying density in the stomach and in the distal GI tract (see red arrows); and one mystery item (see purple arrow).
Image 3. (Click to enlarge.)
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